APPLICATION FORM              ← Click Here                                                                                      

New Patient Application forms are available on our website temporarily due to COVID-19 restrictions.

Health Zone takes new patient applications based on NP availability. Completing an application to be a patient does not guarantee that you will be accepted as a patient. At this time any new patient applications will not be reviewed until August 1, 2020. Each application is reviewed to be sure we are the right provider for you.

The temporary email address to email your Application is

In order for us to consider your application, the following criteria must be met:

  • Completion of a new patient application form
  • Currently have a permanent address in the city of London
  • Do not have a primary care provider (family doctor/physician or Nurse Practitioner)
  • Sign the application form indicating the information provided is true and accurate

Once you apply, please do not call the office to inquire about the status. We will call you only if we are able to offer you an intake appointment.                                                                                                        

****After opening the form, please hit the download buttonin the top right corner and save it to your device. After filling it out, save it again and then add it as an attachment to your email****