Patient Waitlist
(UPDATED: 19-Apr-2020): Vivo Family Medicine is now accepting patients! Please complete this form if you would like to register as a patient with our clinic. Once this is done, we will invite you by phone to schedule a new patient intake appointment.

Please note that an intake appointment must be completed in order for you to become a patient with Vivo Family Medicine. At this time, intake appointments are conducted over the phone.
First Name
Last Name
Clear selection
Date of Birth
Phone Number
Email Address
Street Address
Important Disclaimer
Completing this form places you on our waitlist to become a patient at Vivo Family Medicine. When spaces are available, we will phone you for an intake appointment. You will only become a patient at our clinic after attending the intake appointment.
Family Members
We ask you to kindly re-submit the form for each family member so that we have the necessary information to register you and your loved ones into our clinic.
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This form was created inside of Vivo Family Medicine.