Dear New Patient,
In an effort to ensure that our patients are fully informed of our office policies please read the below statement, then sign and date.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2021 Hush Communications Canada Inc.