New Patients | Luso Medicine

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Become a New Patient of our Clinic

First name*

Last name*

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone*

Email

Birthday

Year

Month

Day

Health Card #*

Version Code:*

I'm aware that completing this form does NOT mean that I'm already a patient. I will wait for the clinic to call me to book my first appointment.

P: 416-551-8181
F: 416-551-8182

Dr. Louis Furtado:

Dr. Martin Theriault:

Monday - 8:30AM - 5:00PM

Tuesday- 8:30AM - 5:00PM

Wednesday- 8:30AM - 5:00PM

Thursday- 8:30AM - 5:00PM

Friday - 8:30AM - 5:00PM

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