Please note if you do not complete the survey or respond by mail in the next 25 days we will assume you no longer need a provider. Your place on the list will not be held and your record will be removed from the Patient Connect NB list.
By completing this form, you are giving the Department of Health and partners involved in the placement of patients with providers the information they need to make all the necessary arrangements. The Regional Health Authorities and Department of Health have the authority to collect this information and will use and disclose it in respect with all applicable legislation.
Please complete the survey to maintain your place on the Patient Connect NB list.