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.  Due to a large number of applications to our clinic, we quickly reached patient capacity and began forming a wait list.  If you have submitted your application, it will be kept on file and you will be contacted in the future should openings become available or additional staff are hired.  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. Nicole Strong says:


    Could you please forward the registration form that you refer to for new patients to be placed on the list for intake, wasn’t quite sure where it was found on the site.

    Thank you,

    1. lnplc says:

      It can be accessed here: http://lnplc.com/wp-content/uploads/2013/06/REGISTRATION-FORM.pdf

  2. Mike Donohue says:

    Good morning,

    My Doctor is retiring this December, therefore I require a replacement for the following:

    My date of birth is: October 09, 1957
    My conditions are: I have CMT & Diabetes with only 3 meds once per day & I am very low maintenance.

    I might only need to see someone once or twice per year for prescription renewal only.

    I think that it is great that the Canadian Nursing has come so far!

    Looking forward to hearing from you,

    Best wishes,

    Michael Donohue

    1. lnplc says:

      Hi Mike

      Please print off a Patient Application form from our homepage, and return it my mail, fax, or email for review by the Clinical Director.


    2. lnplc says:

      It can be accessed here: http://lnplc.com/wp-content/uploads/2013/06/REGISTRATION-FORM.pdf

  3. James Matthews says:

    I am relocating to Thunder Bay due to work and will need a doctor to see from time to time for medical needs

    1. lnplc says:

      Hi James. As a patient at our clinic, you can see our NP-led team of providers. Please click on the Patient Application Form on our homepage to download it, and return it to us.

  4. Judy Gerolami says:

    I don’t have a printer to print off your application for my husband an me to be on your waiting list. Could I pick one up in your clinic please.

    1. lnplc says:

      Hello Judy
      Yes of course, you can come and pick one up at our clinic. You can also call us at 475-9595 or email us at info@lnplc.ca with your address, and we will mail one out to you.

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