Express Medical Care

Clinic Hours: Mon–Fri: 8:00AM – 3:00PM, Sat-Sun: 10:00AM – 3:00PM
X-Ray Hours: Mon, Wed, Fri: 8:30 am – 4:00 pm

Please complete this form to apply for a family doctor. If you would like to speak with us on the phone, do not hesitate to call us at 204‑306‑4259.

    Patient Demographies

    Preferred Pharmacy

    Emergency Contact

    Social History

    Medical History


    Pertinent Medical History

    Previous Hospitalization/Surgeries

    Family History Of Medical Illness

    Social History
    Medications: All Prescribed Medications and Over the Counter (OTC) Medications