Patient Registration
Last name as it appears on your BC Services Card: *
e.g. Simpson
Your answer
Given name(s) as they appear on your BC Services Card *
e.g. Homer Jay
Your answer
Preferred Name (optional):
Your answer
Phone: *
Your answer
Email: *
Your answer
Postal Code: *
Your answer
Birth Year *
Your answer
Birth Month *
Day of Birth *
Your answer
Personal Health Number (PHN): *
Listed on your CareCard or the back of your BC Services Card.
Your answer
Sex as listed on your BC Services Card: *
Gender information and preferred pronoun (optional):
Your answer
Family Doctor (if applicable):
Your answer
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