Please print and complete this form and return it by mail, fax (807-475-9797) or email to info@lnplc.ca. Please note, due to the large number of applications to our clinic, you will not receive confirmation of your submission and we will not respond to requests for updates on the status of your place on the waitlist. If you have submitted your application, it will be kept on file and you will be contacted in the future should openings become available or additional staff are hired. Should you locate primary health care through a different provider, please let us know so your spot on our list can be opened to another patient in need.