New Patient Request

Since fall of 2017, we have tried hard to provide care for as many orphaned patients and family members as we can. We have been operating at our capacity and are no longer able to take on more patients for the present time. Please contact the Madawaska Valley Family Health Team and Health Care Connect to place your name on their waiting list.

Please fill in the request form below to become a patient. We are doing our best to provide quality care to as many families as we can. We are also actively recruiting new doctors to the area. Your name will be added to our waiting list. We appreciate your patience and understanding.

After submitting the form below, please scroll down to the bottom of the page to ensure that a confirmation message appears.

New Patient Request Form

    Your Name (required)

    Your Phone Number (required)

    Your Email (required)

    I am looking for a doctor for: (required)
    MyselfSpouseChildrenGrandchildrenParentsExtended FamilyNon-relative

    Please select an age group:

    Do you have a family member already enrolled in Dr. Chen's practice? (required)
    YesNo

    If yes, what is your relative's name?

    Who was your last family doctor?

    Do you have urgent health care needs?
    YesNo

    How did you hear about us?

    Additional Comments (Please avoid personal health information such as specific diagnosis):

    [recaptcha theme:dark]