R·MEDY MD Health and Wellness

New Patient Registration
Family Medicine


Thank you for your interest in becoming a patient of Dr. Kelli Gustafsson and Dr. Yas Khorami at R·MEDY Health & Wellness.

This short form takes about 10 minutes. It helps the physicians understand your care needs and confirm that the practice can support you well.

Registering does not guarantee acceptance into the practice. Please do not use this form for urgent medical concerns. If you need care now, contact your current provider, call 8-1-1, visit an urgent and primary care centre, or call 9-1-1 in an emergency.

How your information is handled

The information you provide is collected by R·MEDY Health & Wellness to assess your request to become a patient of the family medicine practice, in accordance with British Columbia’s Personal Information Protection Act. It is stored securely, accessed only by the physicians and intake staff, and is never used for marketing. You may ask what information we hold about you, request corrections, or withdraw your request at any time. Privacy questions: privacy@rmedymd.com.

  1. About You
  2. Your Care Needs
  3. Health Summary
  4. Consent & Submit

Step 1 of 4

About You


From your BC Services Card. Optional now — you can provide it later.

Sex assigned at birth *

Helps the physicians plan age- and sex-appropriate screening.

We’ll send your confirmation here.

Preferred method(s) of contact *

Select all that apply.

Need an interpreter? *

Your progress is saved in this browser tab until you submit.

✓

Thank you

Your registration has been received.

The physicians will review your information and the clinic will contact you using your preferred method. Please remember that registering does not guarantee acceptance into the practice.

A confirmation email is on its way. For your privacy, it does not repeat any of the health information you provided.

This form is not monitored for urgent medical concerns. If you need medical attention now, contact your current provider, call 8-1-1 for HealthLink BC, visit an urgent and primary care centre, or call 9-1-1 in an emergency.

R·MEDY MD Health and Wellness

R·MedyMD Health & Wellness  |  rmedymd.com

Suite 416, 750 West Broadway, Vancouver, BC V5Z 1H2