Dr. Sabetai Grunberg

Although not required, preparing your forms before your appointment will make your appointment go much faster. Please be sure to read instructions before you fill out the forms, it is simple to make a mistake without reading the instructions.

Instructions

You may fill out the forms on your computer, and then print them. Please read instructions carefully to ensure you fill out the form correctly.

If you already have Section A

1. COMPLETE PAGE 1
   Open pdf file. On the very first page (refer to picture below) you must TYPE your surname(s) and forename(s)

2. PRINT
   On the first page (as picture below), you must check the boxes for Section B, C, D, and E underneat PRINT SUMMARY. After, click on the pink button that says PRINT SELECTED SECTIONS. If the patient is a child, click on the blue button that corresponds to the child's age and then click on the pink button that says PRINT SELECTED SECTIONS.
3. ATTACH PHOTOGRAPHS
   Attach your photographs using GLUE onto Section A (which you already have from before), Section D, and Section E. If the photos are too large, you may cut them to fit the box. If the patient is a child, please attach photos on applicable sections.
4. SIGNATURES
   There is a total of 3 signatures. Please sign Section B (where it says APPLICANT SIGNATURE on the bottom of the page), Section D, and Section E. Remember if the patient is a child, only sign on applicable sections.
5. WARNING
   DO NOT ANSWER ANY QUESTIONS ON THE FORM AND LEAVE THE DATE FIEDS BLANK. THESE ARE TO BE COMPLETED WITH THE PHYSICIAN DURING YOUR APPOINTMENT.

If you do not already have Section A

1. COMPLETE SECTION A
   Please go to SECTION A (page 2 of the document) and complete the form (see picture below). Under INTENDED CANADIAN DESTINATION you need to say which city and province you plan on staying in. If you don't have your FOSS client ID, leave it blank. If you have any questions about the form, please leave it blank and ask us during your appointment.

2. PRINT
   On the first page of the document, click on the pink button that says PRINT ALL SECTIONS. If the patient is a child, click on the blue button that corresponds to the child's age and then click on the pink button that says PRINT SELECTED SECTIONS.

3. ATTACH PHOTOGRAPHS
   Attach your photographs using GLUE onto Section A (which you already have from before), Section D, and Section E. If the photos are too large, you may cut them to fit the box. If the patient is a child, please attach photos on applicable sections.
4. SIGNATURES
   There is a total of 3 signatures. Please sign Section B (where it says APPLICANT SIGNATURE on the bottom of the page), Section D, and Section E. Remember if the patient is a child, only sign on applicable sections.
5. WARNING
   DO NOT ANSWER ANY QUESTIONS ON THE FORM AND LEAVE THE DATE FIEDS BLANK. THESE ARE TO BE COMPLETED WITH THE PHYSICIAN DURING YOUR APPOINTMENT.