Forms

Welcome to Terra Nova Medical Clinic!
We are a team of 25 healthcare workers, including Family Doctors, Nurse practitioners, Registered Nurses, Licensed Practical Nurses, and Medical Office Assistants who are committed to providing our Richmond community & beyond with the highest quality of healthcare. The following mentioned Family Physicians and Nurse Practitioners are accepting new patients into their practice.

Please note that no doctors or nurse practitioners are not accepting new patients currently.

All patients of the clinic can also book an appointment for a pap smear, allergy shot, baby immunization, or LNT treatment with RN Louise.

Please keep checking our website for any future updates or you can also call the reception.

NOTE: When transferring records to our clinic, always provide us with a digital copy or photocopies and not the original documents. We shred all records that are scanned into our electronic medical record database. Hence, the originals should remain in your or your former doctor’s possession.

  1. Please click on the form link given above and follow the instructions below to complete the “Consent for Release of Medical Information Form”.
  2. In the first section, please fill in your information accordingly. (Name, Address, Date of Birth, etc.)
  3. Under “I authorize:”, please enter:
    The name of your previous physician and clinic.
  4. Under “To release copies of my medical records to:”, please enter:
    The name of physician and clinic that you would like your records to be transferred to.
  5. Under “I authorize release of information of the following portions of my medical record:”, please check:
    All
  6. For the next section, “I hereby release _________ from any and all liability which may arise as a result of my authorized release of records.”, please fill in the blank with:
    Previous physician and clinic.
  7. Lastly, please sign your name and write down the date of form completion.
  8. You have now completed the consent form! Please submit the form to our clinic so it can be faxed to your previous clinic. In the meantime, please be patient as your form gets processed. You will be contacted by your previous clinic with further instructions. Thank you.

For any queries related to form completion, please call the reception at 604-285-2263

We are here to answer your questions 24/7

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