Resources

Printable Forms

  • New Patient Intake Form – Please fill out this form for you and for any other family members who would like to be accepted by one of your family physicians. Once you compete the form, please e-mail the completed form to: thevineyardmc@gmail.com or fax at 587-955-9401 and one of our booking coordinators will call you as soon as possible to book an appointment.
  • Consent to Release Charts – If you wish to receive a copy of your results AFTER reviewing results with the doctor or you would like to authorize your charts be released to your insurance company, employers etc. Please complete the consent of release form.
  • Medical Records Request – If you would like to request a copy of your medical chart from a previous family doctor or specialist please complete this medical records request form. Please note: some clinic require a fee to transfer charts it is the patient’s responsibility to pay fee if required.

Download Intake Form

Download Release Chart

Download Records Request

Useful links