Patient Registration

First Name:  *
Last Name:  *
Sex:  *
Birth Date:
Address:  *
City:  *
Province:  *
Billing Province:  *
Postal Code:  *
Ex. XXX XXX
Home Phone:  *
Ex. 204-XXX-XXXX
Work Phone:
Work Ext:
Cell Phone:
MHSC Card Number:  *
PHIN Card Number:  *
Preferred Doctor:  *

Are you an existing patient ?  * Yes No 

Email Address: *
Password: *
Password Confirmation: *

Verification Code: * akY
Enter the three characters here: *

 * Required Fields

All information submitted to Lakewood Medical Clinic (LMC) through this website is covered under our privacy policy, and are considered part of your patient record. Patient records are protected by law, and regulation of the College of Physicians and Surgeons of Manitoba.