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Forms & Documents

Please choose your applicable clinic location,
in order to get the correct forms and documents for that site.


         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
niagara@medcareclinics.com
Fax:
289-292-0451
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
niagara@medcareclinics.com
Fax:
289-292-0451
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
niagara@medcareclinics.com
Fax:
289-292-0451
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
riverview@medcareclinics.com
Fax:
905-455-0123
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
riverview@medcareclinics.com
Fax:
905-455-0123
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
riverview@medcareclinics.com
Fax:
905-455-0123
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
pc@medcareclinics.com
Fax:
905-687-9338
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
pc@medcareclinics.com
Fax:
905-687-9338
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
pc@medcareclinics.com
Fax:
905-687-9338
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
stc@medcareclinics.com
Fax:
905-646-0202
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
stc@medcareclinics.com
Fax:
905-646-0202
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
stc@medcareclinics.com
Fax:
905-646-0202
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
vaughan@medcareclinics.com
Fax:
905-303-4305
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
vaughan@medcareclinics.com
Fax:
905-303-4305
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
vaughan@medcareclinics.com
Fax:
905-303-4305
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
         
            Title          Description Fee Where to submit          Download         
New Patient Questionnaire This form is designed to streamline your appointment and to reduce the likelihood that important issues are overlooked with your healthcare. Please complete this form prior to seeing the provider.
None
 You can submit this document via:
Email:
welland@medcareclinics.com
Fax:
905-984-8881
In-person at the clinic

Download
Release of Medical Records FROM
MedCare Clinics		 Complete this form when you are requesting your medical records to be released from our clinic to another provider, third-party agency, hospital, etc.. Paper:    $50
USB:       $65
Courier:  $20
(flat fee - no mailing charge if sent via regular mail)
 You can submit this document via:
Email:
welland@medcareclinics.com
Fax:
905-984-8881
In-person at the clinic

Download
Release of Medical Records TO MedCare Clinics Complete this form when you are requesting your medical records to be sent to our clinic and be released from another provider, third-party agency, hospital, etc..
None
 You can submit this document via:
Email:
welland@medcareclinics.com
Fax:
905-984-8881
In-person at the clinic

Download
Schedule of Uninsured Services This is a list of uninsured services that are not covered by the Ontario Health Insurance Plan (OHIP). Patients are responsible for the payment of these services.
TBD
N/A

Download
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