New Patient Intake

1 Code of Conduct: We provide care to all individuals regardless of religious affiliation, race, gender identity, or socioeconomic status. We expect all patients, visitors, and team members to treat one another with dignity and respect. We maintain a zero-tolerance policy for harassment, discrimination, threats, or violence. Any such conduct may result in immediate termination of the care relationship.

2 Appointments: Please arrive 5–10 minutes before your scheduled appointment time. To ensure that each concern receives appropriate attention and high-quality care, consultations may be limited to one primary issue per appointment. If you have additional concerns, please book a separate appointment.

Late Policy: Arrivals more than 10 minutes late without prior notification may be considered a no-show and subject to the No-Show Policy.

Cancellations: Cancellations must be made at least 24 hours before the scheduled appointment time.

No-Show Policy: A $95 no-show fee will be charged for missed appointments. Outstanding no-show fees must be paid in full before any future appointments can be scheduled.

3 Prescription Refills and Renewals: Prescription refills and renewals are not routinely processed by fax or telephone. Please schedule a follow-up appointment, either by telephone or in person, before your medication runs out to allow adequate time for review and renewal.

4 Uninsured Services: Services not covered by the Medical Services Plan (MSP), including sick notes, third-party forms, cosmetic procedures, and other non-insured services, are subject to applicable fees. Fees will be communicated in advance whenever possible.

5  Electronic Communication Consent: I consent to the clinic communicating with me electronically, including through email, SMS (text messaging), and fax. I understand that electronic communications may involve privacy and security risks and cannot be guaranteed to be completely secure. I accept these risks and authorize the clinic to use these methods to communicate appointment reminders, test results, and other healthcare-related information with me.

I understand that I may withdraw or modify this consent at any time by providing written notice to the clinic.

6 Termination of the Physician–Patient Relationship: The physician–patient relationship may be terminated when appropriate, including in circumstances involving harassment or abusive behaviour, repeated or routine lateness, excessive or inappropriate use of outside clinics for ongoing care, or a significant breakdown in the physician–patient relationship.

By this document, you declare you have read it in its entirety and agree to abide by the Code of Conduct and Practice Policies of Fresh Bay Medical Centre.