CanCare Clinic for Canadians and Visitors

Se Habla Español 6399 38th Ave. N.St. Petersburg, FL 33710 (727)-384-6411 Nous Parlons Français

Registration

CanCare Clinic is dedicated to providing the best Healthcare available. Our service is personal so you can be confident in knowing that your personal needs are being met. In addition to their expertise, our staff members bring warmth, caring and sensitivity. A link to our Clinic registration forms in Word and PDF is below, or you can us our Online Registration Form.

Clinic Registration - PDF Document (Adobe Reader required)
Clinic Registration - Word Document

Fill out the form below and we will respond to you by the next business day.

Personal Information
Last Name:
First Name:
MI
Street Address in Canada:
Apartment Number:
City:
Province:
Zip Code:
Canadian Phone Number:
Florida Phone Number:
Email:
Birth Date:
Florida Street Address
Apartment Number:
City:
State:
Zip Code:
Travel Insurance Information
Company:
Policy #:
Agent:
Province:
Phone Number:
Company Email:
Name on Policy:

Bring in any CanCare Clinic or Bay Area Medical advertisement to receive a
$10 discount on our Cardiovascular Heart and Stroke Screening.
Our advertisements can be found in the St. Pete Times Neighborhood section and other local publications.

Se Habla Español 우리는 한국어를 말한다 Nous Parlons Français

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