huronianplc.ca
Huronia Nurse Practitioner-Led Clinic 3331 Line 4 North, RR1 Shanty Bay, ON L0L 2L0 Ph) 705-835-7545 Fax) 705-835-6424 PLEASE RETURN FORMS VIA: FAX, MAIL OR DROP OFF TO CLINIC CLIENT APPLICATION FORM-CHILD/ADOLESCENT The Huronia Nurse Practitioner-Led Clinic collects, uses and discloses your personal information in compliance with the guidelines of the Personal Health Infor