Steelcity Medical - New patient information
This form may take about 15 minutes to complete. It includes a brief overview of your medical history, including your current medications. Individuals are contacted in order from when they submit this form. Higher need and/or complex patients may be prioritized.

Note: Each family member must submit their own form.
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Email *
First name
 *
Last name
 *
Health card number *
Date of birth *
MM
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DD
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YYYY
Phone number *
Address (including city) *
Name of current family doctor (if applicable)
Reason for looking for a new doctor (if applicable)
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