Primary Health Care

Forms are listed alphabetically in Portable Document Format (PDF). To view and print the forms, you need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe Web site.

Click on the form title to open the form. You can fill-in the form on your screen and print it, or use the disk icon on the Reader toolbar to save a blank copy of the form to your computer. Filled-in forms cannot be saved.

4832-84 Request for Primary Health Care Enrolment Material Fill & Print
4573-84 Request to Change Designated Physician Form Fill & Print
4431-84 Unattached Patient Declaration Fill & Print
3624-84 Request to Remove Patient Fill & Print
4316-84 Patient Enrolment Batch Header Fill & Print
4324-84 Request for an Interim Assigned Roster Report Fill & Print
4340-84 Time and Location of After Hours Services Fill & Print
4342-84 List of Locations Where Group Services are Regularly Provided Fill & Print
4367-84 Primary Health Care New Patient Declaration Fill & Print

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free in Ontario only)
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm