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DR. INGBER TRANSFER TO DR. HIRA NAZ PATIENTS
Please fill out the form only if you’ve received a notification regarding a transfer.
Please complete to be assigned to Dr. Hira Naz as your new family physician
First name
*
Last name
*
Birthday
*
Year
Month
Month
Day
Email
Health Card Number (including the 2 letters)
I want to continue as a patient of Malvern Medical Centre with Dr. Naz as my new physician
*
Yes
No (I will seek care at another clinic)
SUBMIT
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