Join Our Guelph Practice

Dr Nipun Madan and Dr Seema Gupta presently have a wait list for accepting new patients at our Guelph office.  You can find out more about Dr Madan and Dr Gupta in the “meet our team” tab of our main page.

To become patient kindly  complete the online form below and we will mail you an enrollment form.

First Name, Last Name (required)

Street Address (required)

City (required)

Postal Code (required)

Age

Preferred Email (required)

Home #

Mobile #

Are you registered with Health Care Connect?(required)

Previous Family Doctor (required)

Medications (required)

If you are not currently taking any medications, please write "None" in the field above.

Medical Conditions

Additional Message

  • captcha
  • Enter the characters exactly as you see them in the field below.