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F.A.M.Y Medical – New Patient Application

Page 1 of 10 · Before you begin

Before you begin

Completing this form adds you to our wait list to join the practice — it does not register you as a patient. If a space becomes available we will contact you using the details you provide. Please read the clinic policies and the notice below before proceeding.

Please read before continuing

Scroll inside the box to read all of it.

F.A.M.Y Medical – Clinic Policies

1. Booking and Cancellation Policy

– Appointments may be booked by phone only (online booking coming soon).

– Please leave a detailed voicemail including your full name, phone number, the name of your family doctor, and a brief description of your medical concern.

– All visits must be pre-booked via phone. Walk-ins are NOT accepted.

– Same-day appointments must be booked by phone and become available after 9:00 a.m. on a first-come, first-served basis.

– Please arrive 5–10 minutes before your appointment to be checked in.

– Patients arriving more than 5 minutes late may be marked as a “no-show.”

No-Show & Late Arrival:

– Missed appointments or cancellations with less than one business day’s notice will result in a $100–$150 fee.

– Recurrent missed or late appointments may result in dismissal.

If You’re Running Late:

– If delayed due to traffic or unforeseen circumstances, leave a voicemail and we will try to accommodate you when possible.

2. Outside Use Policy

– Your care is best managed when all medical visits are coordinated through your Family Physician.

– Outside providers often do not send us records, increasing the risk of errors.

Ministry of Health Impact:

– When you visit a walk-in clinic, the Ministry charges your family physician.

– This occurs even though your family physician was not involved in your care.

– Please contact F.A.M.Y Medical first for all non-emergency concerns.

Access to Care:

– Same-day appointments (after 9:00 a.m.) and After-Hours Clinic visits are available.

– After-Hours notes are shared with your Family Physician.

Emergency Visits:

– Emergency department visits are appropriate for urgent issues and do not affect your patient status.

– Repeated non-urgent walk-in use may result in discharge.

3. Medication Renewal Policy

– Medication renewals without a visit are not covered by OHIP.

– F.A.M.Y Medical provides free renewals when your pharmacy sends the request directly.

Processing Times:

– Routine renewals are processed once per week.

– Please allow 1–2 weeks for completion.

– Request renewals 2–3 weeks before running out.

Rush Requests: 24-hour rush renewals require a $25 fee.

Physician Discretion:

– Renewals may be declined if an assessment is required; an in-person or virtual appointment may be necessary.

4. Controlled Substances Policy

– Controlled substances include opioids, benzodiazepines, stimulants, and certain sleep medications.

– These medications carry risk and require close monitoring.

Controlled Substances Agreement:

– Patients must sign an agreement outlining safe use and follow-up expectations.

Prescribing Rules:

– Controlled substances are prescribed only by your Family Physician at F.A.M.Y Medical.

– They must not be obtained elsewhere unless approved.

– Renewals cannot be done by fax or pharmacy requests; appointments are required.

Monitoring:

– Monitoring may include urine drug screens and Narcotics Monitoring System review.

– Non-compliance may result in tapering, discontinuation, or termination of care.

5. Harassment Policy

– F.A.M.Y Medical maintains a zero-tolerance policy for harassment, abuse, or inappropriate behaviour.

Prohibited Conduct:

– Yelling, swearing, aggressive language

– Threats or intimidation

– Physical aggression or unwanted contact

– Sexual harassment or inappropriate comments

– Discriminatory remarks

Enforcement:

– Incidents may result in immediate dismissal and may be reported to authorities.

6. AI-Scribe Documentation Policy

– F.A.M.Y Medical uses AI-Scribe to assist with accurate medical documentation.

– With consent, AI-Scribe may transcribe parts of the visit in real time.

– AI-Scribe does not diagnose or make clinical decisions.

Privacy:

– Complies with PHIPA.

– AI-Scribe does not record or store audio.

– Only physicians and authorized staff access completed notes.

– All notes are reviewed and approved by your physician.

Choice: Patients may decline AI-Scribe at any time without impact on care.

7. Uninsured Services

– Certain services are not covered by OHIP and require out-of-pocket payment.

Common Uninsured Services:

– Sick notes

– Insurance or employment forms

– Driver’s medical forms

– Medical record transfers

– Prescription renewals without an appointment

– Rush prescription renewals (24 hours): $25

– Cosmetic/elective procedures

Payment: Payment is required at the time of service (cash or e-transfer).

8. Third-Party Medical Reports

– Third-party reports (insurance, employer, legal, government) are not covered by OHIP.

– Completion time is typically 30–45 days. We strive to complete requests as soon as possible.

– Fees must be paid before completion.

9. Medical Learners / Teaching Practice Policy

– F.A.M.Y Medical is a teaching practice with supervised Medical Students and Resident Physicians.

Medical Students:

– Students do not practice independently and are fully supervised.

Resident Physicians:

– Residents are licensed doctors in training and may assess patients independently.

– All care is reviewed by your Family Physician.

Learner Participation:

– You may request not to have a learner involved, and we will accommodate when possible.

Before you continue

Important notice – please review carefully before submitting your form.

INCOMPLETE FORMS will NOT be processed and will be securely destroyed.

If, during your Meet & Greet appointment, any required information is found to be missing, your appointment may need to be rescheduled to allow completion of your intake and medical chart.

Status updates will not be provided, and submission of this form does not guarantee acceptance as a new patient.