Main Contact:__________________________________________________________________________________________

Patient’s Name: ________________________________________________________________________________________

Patient’s Name: ________________________________________________________________________________________

Patient’s Name: ________________________________________________________________________________________

Patient’s Name: ________________________________________________________________________________________

Patient’s Name: ________________________________________________________________________________________

Phone Number: _____________________________________

Email:______________________________________________

For verification of eligibility for this program we require the CAF member’s:

Name: ___________________________________________ Work Phone:___________________________________

Rank:____________________________________________ Work Location:_________________________________

Current status: Serving Retiring Releasing

Calian is pleased to offer a Military Family Doctor Network (MFDN) in support of the Military Families across Canada. The program is presented in coordination with the local Military Family Resource Centre. This is the beginning of a national program that will link Military Families with doctors within the network of 140 Calian Primacy health clinics.

If you require a family doctor, follow these three simple steps:

Step 1: Complete the form Step 2: Fax to: 1-888-511-0219 Scan and email to: contact@primacy.ca Call: 1-877-633-7722 x 550 Step 3: A representative from Primacy will contact you at the phone number provided below

Physician preferences: Male Female Either

Language Preference: ______________________________________________________

Medical coverage: Ontario Health Other: ________________________________________________

In what area do you live? Please include your postal code:______________________________________________

How did you learn about the MFDN ? ____________________________________________________________Note: Please ensure that you inform your doctor when you change doctors as another family may be waiting.Disclaimer: MFDRP is limited to connecting CAF families with participating physicians. MFRC-Toronto is not involved in the patient-doctor relationship beyond the introduction.

Revised 23.09.15 MFDN REF #

WALK-IN CLINICSPlease see reverse for a list of convenient Walk-In Clinics should you require immediate medical assistance.

As the Canadian Armed Forces long-time health services partner, Calian is honoured to extend our services to support Canadian Military Families within the communities where they live, work and play.

Military Family Doctor Network

* Call for hourswww.primacyclinics.ca

Pharmacy on-site at each location!

Ajax Family Care Centre

30 Kingston RoadWest Ajax, ON L1T 4K8 (905) 426-2501

Oak Park Family Care Centre

201 Oak Walk Drive Oakville , ON L6H 6M3 (905) 257-3297

Leslieville Medical Centre

17 Leslie St Toronto, ON M4M 3H9 (416) 465-6606

Doctors on Bayview

15900 Bayview Avenue Aurora, ON L4G 7Y3 (905) 726-9755

Harmony Medical Clinic

1385 Harmony Rd North Oshawa , ON L1H 7K5 (905) 436-9646

Weston Road Medical Clinic

2549 Weston Road Toronto, ON M9N 2A7 (416) 240-8282

Milton Family Care Center

820 Main Street East Milton, ON L9T 0J4 (905) 864-9898

Golden Mile Walk-In Clinic

1880 Eglinton Ave EastScarborough, ON M1L 2L1 (416) 285-7575

North York Family Physicians After Hours2901 Bayview Avenue Toronto, ON M2K 2S3 (416) 491-6338

West Mississauga Care Centre3050 Argentia Road Mississauga, ON L5N 8E1 (905) 785-3627

Carlton & Church Medical & Walk-In Clinic60 Carlton Street Toronto, ON M5B 1J2 (416) 646-1890

Lansdowne Dundas Medical Clinic200-222 Lansdowne Ave.Toronto, ON M6K 3C6 (647) 725-6555

Trinity Medical Centre & Travel Clinic

18120 Yonge Street Newmarket, ON L3Y 4V8 (905) 895-0008

Dufferin Family Care Centre

51 Gerry Fitzgerald Dr Toronto, ON M3J 3N4 (416) 739-1562

Don Mills Medical Clinic

825 Don Mills Road Toronto, ON M3C 1V4 (416) 383-1251

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Primacy Walk-In ClinicsWhile you are waiting to be referred to a Family Physician, we welcome you to visit

one of our Walk-in Clinics with any urgent care needs.

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