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  1. I consent to be contacted by email
  2. I agree to contact by phone if I do not hear back by email within 1 business day
  3. I understand that by submitting this request no Doctor-patient relationship has been established
  4. I understand that this is a request for an appointment to the Rapid Access Virtual Encounter with the team at Northumberland Hills Hospital
  5. I am a resident of Ontario and accessing this service from Canada and have a valid OHIP card which will be required at the time of virtual visit.
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