Accepting New Patients — Family Doctor in Ajax, Ontario

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Personal Information

Basic contact and identification details. All fields marked * are required.

Full Name *

Date of Birth *

Gender *

Health Card (OHIP) Number *

Version Code

Health Card Effective Date

Health Card Expiry Date *

Street Address *

City *

Postal Code *

Phone Number *

Email Address *

Preferred Method of Contact

Phone call Text message Email

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Step 2 of 5

Clinic Fit

Our clinic has specific expectations around availability, continuity, and how care is accessed. Please read each question carefully.

Have you reviewed the clinic's hours (Mon–Fri 9:00 am–5:00 pm) and confirmed they work for you?

Yes No

Can you commit to using this clinic as your primary healthcare provider?

Yes No

If you require urgent medical care outside clinic hours, are you willing to use a hospital emergency department instead of a walk-in clinic?

Yes No

Are you comfortable with potential wait times, knowing that you will receive unrushed, high-quality care?

Yes No

Are you comfortable with the fact that Dr. Yu takes a root-cause approach to care, rather than just symptom management?

Yes No

How often do you typically seek medical care in a year?

Rarely (0–1 times) Occasionally (2–4 times) Regularly (5–8 times) Frequently (9+ times)

Do you have any specific accessibility needs?

Please indicate that you understand our no-walk-in-clinic policy

I understand and agree I need more information

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Step 3 of 5

Your Health & Situation

Help us understand your current situation and what brings you to us.

Do you already have a family doctor? If so, why are you looking for another?

How would you describe your approach to health and wellness?

Proactive — I prioritize prevention and lifestyle Reactive — I seek care when something is wrong Mixed — somewhere in between I am still developing my approach

Are you open to making lifestyle changes if it helps improve your overall health?

Yes, very open Open if necessary Not sure yet Prefer to focus on medication/treatment

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Care Philosophy & Approach

Our clinic offers care that goes beyond standard family medicine. These questions help us understand whether our approach resonates with you.

Are you comfortable working with a doctor who prioritizes preventive care and long-term health strategies?

Yes No

Do you prefer to explore the root causes of your health challenges rather than just treating symptoms?

Yes No

Are you open to integrative approaches such as group medical visits, acupuncture, or mindfulness-based strategies?

Yes No

Are you interested in learning how Presence Therapy can help with mental clarity and emotional well-being? (optional)

Yes, very interested Somewhat interested Not at this time

Would you like to complete the Presence Therapy Evaluation Form as part of your application? (optional)

Yes No Maybe later

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Review & Consent

Please confirm the following before submitting your application.

Additional comments (optional)

Please note: Submitting this application does not guarantee enrolment. We will review your application and contact you within 3–5 business days.

Step 5 of 5

New Patient
Application

The Eight Doorways In

New PatientApplication

The Eight Doorways In

New Patient
Application