Complete copy of the file

Q: Complete copy of the file

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Q: Complete copy of the file

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Q: Complete copy of the file

[gravityform id="44" title="false" description="false"]

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Once you complete the request, we will be happy to respond to it within 15 business days.

The complete copy of the file is not a service covered by Medicare. Therefore, fees apply, based on the Federation of Physicians' fee scale.

Please remember to check your ''spam'' or ''junk'' folder if you do not receive a response from us within 15 business days.

Identification*
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Email*
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Phone*

Date of birth*
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Health Insurance Number (RAMQ)*
(No space)

Fee for complete copy of the file
Price:

Transmission mode*

I will pick up the documents at the clinic once you notify me that it is ready (fee for the completion of the request only)

Highly secure email (fee for the completion of the request + $20)

Mail (fee for the completion of the request + $30)

GST
Price: $ 0.00 CAD

QST
Price: $ 0.00 CAD

Total
$ 0.00 CAD

Please choose a password to receive your file through a secure email*
(You will receive a copy of your documents via a highly secure email. You will need to enter the password you chose in order to access your file.)

Address*
Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code

Confidential document transmission agreement*
I hereby certify that I am the person identified in this request and I consent to receive my request for this service, as formulated.

Payment

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Supported Credit Cards: MasterCard, Visa
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Complete copy of the file

Complete copy of the file

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