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If you or your child is a current patient of Dr. Bodig, Clarke , Di Paolo or Pinard, and you have not signed a new FHO roster form, or you have not signed a form for your child, then please download one of the following forms and either mail the completed form to our office at the address above or drop it off.  Thank you.

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ADULT ROSTER FORM

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CHILD ROSTER FORM

510 Raglan Street North

Upper Floor, West Side

Renfrew, ON

K7V 1P5

For Life-Threatening Emergencies Call 911
613 433 5712

© 2015 Renfrew Medical Associates.

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