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Fill out this new patient form

Please complete this form to apply for a family doctor. If you would like to speak with us on the phone, do not hesitate to call us at:
204-515-6236 or 204-808-4222
Choose your preferred clinic location
Rothesay
Ness
Can we leave messages for you
Yes
No
Birthday
Year
Month
Day
Multi-line address
ROTHESAY MEDICAL CLINIC
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