Transcription of RAPID ACCESS CLINIC CONSULTATION REQUEST FORM
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RAPID ACCESS CLINIC CONSULTATION REQUEST FORM
45 Mill Street Toronto, Ontario M5A 3R6 Tel: 416 869 DERM (3376) Fax: 416 365 SKIN (7546) RAPID ACCESS CLINIC - CONSULTATION REQUEST form This Dermatology RAPID ACCESS CLINIC (RAC) combines the best of walk-in clinics and specialty care provided by Dermatologists certified by the Royal College of Physicians of Canada. Referring Provider: OHIP Billing #: Office Phone: Fax: Family Doctor: Family Doctor s Phone: Patient Name: Health Card #: Version Code: DOB (D-M-Y): Address: Phone: Alternate: Email: Reason for Referral: Additional Info: RAC HOURS OF OPERATION : MONDAY FRIDAY 8:00 AM TO 11:00 AM Improved ACCESS with reduced wait times All dermatological conditions seen, not just urgent cases Wound care is outsi
45 Mill Street Toronto, Ontario M5A 3R6 Tel: 416 869 DERM (3376) Fax: 416 365 SKIN (7546) www.avantderm.com . RAPID ACCESS CLINIC - CONSULTATION REQUEST FORM. Confirmation or booked appointment not required.
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