New Patient Registration Start your child’s journey with Kidcrew — expert care, made simple. New Patient RegistrationWe'd like to register our child with:Please confirm your child will be a NEW Primary Care patient at Kidcrew:* Yes, my child is not currently a Primary Care patient. No, we are returning patients. *Important: This form is for New Primary Care patients only. For any other type of visit, please go to Kidcrew.com/booking - or CLICK HERE! Thank you, Team KidcrewYour Contact InfoParent's Name* First Name Last Name Email*We will use this email to confirm your appointment. Phone*Please include your phone number, including area code.Your Child's InfoChild's Name* First name Last Name Child’s Date of Birth (or Expected Due Date if Unborn):Health Card Number and Version CodeHelps us prepare, but you can leave this blank if needed.Your child's home address including Postal Code:For your child’s records and appointment confirmation.Your child's preferred Pharmacy information:If you have one, this helps streamline prescriptions.Please Double-Check All Info Above (spelling, etc.)*Please double check all your info, this saves time and will speed up the registration process. YES, I Double Checked How Did You Hear About UsWe love knowing how Kidcrew families connect with us — every story helps. Google Search Google Reviews Social Media (Facebook / Instagram) Word of Mouth / Friend Referral Physician Referral Walk In / Urgent Care Visit (Optional) Additional NotesAnything else you'd like us to know?Confirm Your RequestIMPORTANT: Please wait for the confirmation message before closing this window.CAPTCHA
