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Respirology
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  • 1
    Format: Last name, First name
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  • 2
    Leave blank if you do not have a health card (i.e Out of country, refugee etc.)
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  • 3
    Enter phone number WITHOUT any dashes or '1" in front of it. For example: 9058979228. Enter the SAME PHONE NUMBER that you have been receiving text messages from the clinic.
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  • 4
    Enter in the following format: YYYY-MM-DD. For example: 2020-12-31 for December 31st, 2020
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  • 5
    Enter your address with your postal code. For example: Suite 110 - 21 Queensway West, Mississauga, ON L5B1B6
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  • 6
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  • 8
    Example: Smoke 3 times a day, 2 cigarettes each time
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  • 12
    Example: Diagnosed 3 years ago, was treated for 6 months in 2018
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