New Patient Applications

Patient Registration Form

Please print and complete this form and return it by mail, fax (807-475-9797) or email to lnplcregistration@tbaytel.net.  We will be booking intake appointments as patients are able to be accepted to the clinic.  If you have submitted your application, it will be kept on file and you will be contacted.  Should you locate primary health care through a different provider, please let us know so your spot on our list can be opened to another patient in need.


  1. Irina Mouritsen says:

    Your NP’s were recommended by a friend. I just moved here from Toronto and I’m looking for a NP.
    Thank you,

    1. lnplc says:

      Hello Irina

      I’ve sent you an email with a patient application attached. The form can also be found on our main website. Please email/fax/send it back to our clinic and it will be reviewed by the NPs.

      Please contact us if you have nay further questions.

  2. Amy says:

    I cannot find the application, could I get one via email as well?
    Thank You so much!

    1. lnplc says:

      Hi Amy

      You can click on the “New Patient Applications” at the top of our homepage and download a form there. If you do not yet have one, please email lnplcregistration@tbaytel.net and we will send you one.


  3. Randy says:

    Hi there. We are moving back to TB next month & being a diabetic, a NP would be ideal!

    Could you emial me an application too please so we can get into the system.

    Tnx from Grande Prairie!

    1. lnplc says:

      Hello Randy

      Sure, I’m emailing you an application now. It can also be downloaded form the link on our home page. You can submit it back to us by email, fax, snail mail, or come and drop it off at the clinic. Welcome back to Thunder Bay!

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