New Patient Intake Form

If you are not an existing patient at the clinic and are looking for a Family Doctor to accept you into their practice, please use this form.

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This form is only for patients who wish to be accepted by the following doctors:

• Dr. Alexander Clunies-Ross

• Dr. Yousra Al Tomi

• Dr. Anant Shah

• Dr. Elizabeth Perez (See different intake process below)

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Please complete and submit the form. Our team will contact you to schedule your initial meet-and-greet appointment with one of our doctors.

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