Patients — Bluewater Medical Clinic

FAMILY MEDICINE

SERVICES

Bluewater Medical Clinic is proud to provide the following array of services to our patients:

Full Service Family Medicine (Pediatrics to Geriatrics)

Obstetrical Care

Prenatal Care

In-Patient Care

Nursing Home Care

Joint Injections

Excisions and Biopsies

Infant Circumcisions

Immunizations

Driver’s Medical Forms

Insurance Forms

NEW PATIENT

REGISTRATION

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

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Date of Birth

MM

DD

YYYY

Medical History