Chart Transfer (Dr. D. Séguin)
How do I request a chart transfer?
(For the patients of Dr. D. Séguin only)
Normally the ''Chart Transfer Request'' Form needs to be filled out in person so we can confirm your identity. In these exceptional times however, we have come up with a way for you to register on-line.
1)Download and print the consent form here
2)Complete the form. Please note the following:
- In the field “Photo ID” enter the type of photo ID you are using (e.g. driver’s license) and the number. The ID must show your signature
- Skip the field “Clinic witness” and “Patient label”
3) Send the signed form and copy of the photo ID by email to firstname.lastname@example.org
We will place the form and photo ID in your chart, and one of our staff members will be in contact with you to proceed with payment.