Patient Enrollment Request

Please note that this form should only be completed once per individual. Submitting multiple forms may delay the processing of your request. We kindly ask for your patience and understanding as our team works to review and respond to your enrollment request. Please allow up to 10-15 business days for a team member to get back to you with further information. A valid OHIP card is required in order to be registered with a family doctor.

***LIMITED SPOTS AVAILABLE***

1. Choose your clinic or provider

Select the MedCare Clinics location and provider you wish to request for enrollment. One form per person.

Select Clinic / Healthcare Provider
Select Clinic / Healthcare Provider
BRAMPTON - Dr. Ankit Jani (MedCare Clinics @ Riverview Heights)
BRAMPTON - Dr. Ifechukwudelu Ezumba (MedCare Clinics @ Riverview Heights)
BRAMPTON - Dr. Gagandeep Kaur Singh (MedCare Clinics @ Riverview Heights)
BRAMPTON - Dr. Gagandeep Kaur Singh (MedCare Clinics @ Walmart Mayfield)
BURLINGTON - Dr. Ifechukwudelu Ezumba (MedCare Clinics @ Burlington Medical Centre)
HAMILTON - Dr. Harleen Singh (MedCare Clinics @ Walmart Hamilton) -*Patients 18+ years of age only.
MARKHAM - Dr. Anthony Pelaccia (MedCare Clinics @ Walmart Markham)
NIAGARA FALLS - Dr. Felicien Mbuyi (MedCare Clinics @ Niagara Square)
NIAGARA FALLS - Dr. Jason Morin (MedCare Clinics @ Niagara Square)
NIAGARA FALLS - Dr. Onyedika Oti (MedCare Clinics @ Niagara Square)
NIAGARA FALLS - Dr. Kabuya Mudingayi (MedCare Clinics @ Niagara Square)
ST. CATHARINES - Dr. Rajinder Maan (MedCare Clinics @ Walmart Pen Centre)
ST. CATHARINES - Dr. Chibuzo Chukwudum (MedCare Clinics @ Scott Street Medical Centre)
VAUGHAN - Dr. Anthony Pelaccia (MedCare Clinics @ Walmart Vaughan)
WELLAND - Dr. Yabondo Mukendi (MedCare Clinics @ South Pelham Road)

2. Your name and how we can reach you

Use the same spelling as on your health card.

3. Ontario Health Insurance Plan (OHIP)

Match the name and numbers printed on your card.

4. Home address

We use this for enrollment and to reach you if needed.

5. Health information

We need a short summary for the provider. You can use the suggested words in italics in each box if they apply to you.

If you have no known drug allergies, you may use NKDA (no known drug allergies), or list your allergies.
List ongoing conditions, or use None if you have no conditions to report.
Include past surgery or hospital stays, or use Never if not applicable.
Name and dose if you can, or use None if you are not taking any.

Please read and agree before you submit. All personal and health information is kept confidential and secure in accordance with applicable laws. MedCare Clinics operates under a shared care model. Completion of this form does not confirm a doctor-patient relationship. MedCare Clinics will not disclose any personal or health information to any third party (without express prior consent) except to those individuals necessary for the provision of medical services in accordance with applicable law. For all medical/physician services, a valid OHIP card must be presented at each visit to receive medical care. In the event an expired or invalid OHIP card is presented, patients will be billed directly for the medical appointment before the appointment. This payment is non-refundable. For all medical services not covered by OHIP, payment is required at the time of service. Some payments are non-refundable and may be subject to a processing fee. MedCare Clinics provides all patients with the required receipts and documents for submission to insurance companies or any 3rd party coverage providers. Please note that each patient's insurance agreement is an agreement between themselves and the insurance company directly. In the event that any insurance company or 3rd party coverage provider does not completely reimburse or reject any claim provided at MedCare Clinics, the patient remains responsible for all fees. Please note that certain healthcare providers at our facility exclusively see adult patients (18 years of age and older). We recommend verifying provider eligibility for younger patients prior to booking an appointment. Not all services are available and are subject to Provider availability. Please check with your local MedCare Clinics for further information. To ensure you receive the care you need, we recommend contacting your local MedCare Clinics directly. The clinic staff can provide you with up-to-date information about the services available at your specific location, as well as the availability of healthcare providers. Each individual patient is required to complete and submit a separate Patient Enrollment Request Form. Enrolling one family member does not automatically enroll other family members. Separate forms must be completed for each person seeking enrollment. By submitting this form, you acknowledge and understand the role of a physician assistant, clinical assistant, scribe and a nurse practitioner and consent to be seen and have healthcare services provided to me by a physician assistant, clinical assistant, scribe and a nurse practitioner working under the direct supervision and involvement of a licensed physician. I acknowledge that I have read and fully understand this form, disclaimers, terms of use, patient responsibilities and policies listed on the MedCare Clinics’ website. I consent to the conditions outlined herein, as well as any other instructions that the healthcare providers may impose to communicate with me as well as all of MedCare Clinic’s policies, terms and conditions. By signing this document, I agree to waive all claims (including but not limited to, medical malpractice) that I have or may have in the future against MedCare Clinics. I agree to release MedCare Clinics from all liability for any loss, death, damage or injury that my next of kin or I may suffer for any negligence, breach of contract, malpractice, or breach of any statutory or other duty of care. I also expressly consent and authorize MedCare Clinics to contact me via email or text messages for news and updates in regard to the clinic and its services and appointment reminders. All references to MedCare Clinics include its directors, officers, physicians, employees, agents and affiliates or other related companies (including any successor companies to MedCare Clinics). By submitting this form, you agree to the terms and conditions set forth by the clinic, including the collection and use of your personal information as required for patient enrollment and care.

6. Verify and send your request

Complete the reCAPTCHA, then click Submit Request.

Submitting…

Frequently Asked Questions

Please allow approximately 10–15 business days for the clinic team to review and respond to your enrollment request. Submitting the form more than once may delay processing. If you have an immediate medical issue, please visit your local MedCare Clinics. You may request an appointment online or walk-in. We are open 7-days a week, including late evenings and weekends.

No. Submitting the Patient Enrollment Request form does not automatically confirm registration or establish a doctor-patient relationship. A team member will review your request and contact you with further information if enrollment is available.

Yes. A valid OHIP card is required to register with a family doctor and must be presented at each visit for insured medical services. If your OHIP card is expired or invalid, you may be billed directly for the appointment.

Patients who already have a family doctor may not be eligible for enrollment, depending on clinic policy and physician availability. Patients should not submit duplicate enrollment requests unless they are actively seeking to transfer care.

Although you may be registered with a family doctor at MedCare Clinics, your doctor may not always be on site during all clinic hours. Physician schedules are subject to change without notice due to availability, emergencies, vacations, or other clinical responsibilities. MedCare Clinics operates under a shared care model. A doctor, physician assistant, clinical assistant, scribe, medical assistant, nurse practitioner, nurse, dietician, specialist, nutritionist and/or pharmacist may connect with you to assist with your healthcare concerns. For more information, please visit our Terms of Use.

MedCare Clinics operates under a shared care model. Depending on your healthcare needs and provider availability, your care may involve a family doctor, nurse practitioner, physician assistant, clinical assistant, nurse, medical assistant, scribe, specialist, or other qualified healthcare team member.

Yes, patients are encouraged to arrange the transfer of relevant medical records from their previous family doctor or healthcare provider to MedCare Clinics. This helps your new provider better understand your medical history and continue your care appropriately. Patients can find the appropriate Release of Medical Records form on our website or ask the front desk receptionist.

Provider availability can change. Patients are encouraged to contact their local MedCare Clinics location directly for the most up-to-date information about appointment availability, and services offered at that location.

A Family Health Group, also known as an FHG, is an Ontario primary care model where a group of family physicians work together to provide comprehensive primary health care to enrolled or assigned patients. Under this model, patients continue to receive care from their family doctor, while the group practice supports better access to ongoing care, including after-hours services. An FHG may also support a more coordinated, team-based approach to care, where physicians and clinic staff work together to help patients access timely appointments, follow-up care, referrals, test results, and ongoing health management. While the exact team structure can vary by clinic, the goal is to provide patients with more consistent, connected, and comprehensive primary care. The purpose of an FHG is to improve access, continuity of care, coordination, and long-term health support for patients within a family medicine practice in Ontario.

To help ensure timely access for more patients, appointments may be more focused. Patients may be asked to address one or two main concerns per visit so the healthcare provider can provide proper attention and care.

If you have several concerns, you may be asked to book additional follow-up appointments. This allows each concern to be properly reviewed and addressed without rushing your care.

We strongly encourage patients to book appointments with their own family medicine team whenever possible. Your family doctor and clinic team have access to your medical history, medications, previous investigations, and ongoing care needs.