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Contact Information Update

Contact Information Update

This form is for members of Doctors Manitoba. If you need to change your address with Manitoba Health, Seniors and Active Living (your health card) please visit Manitoba Health here.

Only complete the fields that need to be updated.

First Name *

Last Name *

Date of Birth *

Used for identity verification

Email *

Home Address

Street Address

City

Province

Postal Code

Country

Effective Date

Please enter the effective date of the address change.

Office Address

Clinic Name

Street Address

City

Province

Postal Code

Country

Effective Date

Please enter the effective date of the change.

Home Phone Number

Cell Phone Number

Office Phone Number

Please confirm your communication preferences

Doctors Manitoba will communicate with you via email where available unless otherwise specified. Please note that certain items are not available by email (membership invoices, insurance invoices and rebate applications.)

Communications Preference

Mail

Preferred Mailing Address

Home

Office

Comments

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