New Patient

Register as a New Patient

We are expanding our team!

Dr. Ali Ranjbaran and Dr. Leila Valaei are joining our clinic on August 17th.

Please fill out the form below to join the waitlist for your preferred physician. Select your preferred physician and provide your information — our team will reach out as soon as their schedule opens.

Available Physicians

Family Doctor

Dr. Ali Ranjbaran

Special interest in men’s health, urinary concerns, sexual health, metabolic health, and chronic disease management.

Family Doctor

Dr. Leila Valaei

Special focus on women’s health, contraception, prenatal and postnatal care, menopause management, and hormonal concerns.

FAMILY DOCTOR

Dr. Chris Yoon

Committed to providing comprehensive care for individuals and families in North Vancouver, offering both in-person and virtual visits.

New Patient? Fill up the intake form

New patient Intake Form

Welcome to Our Family Practice at Five Points Medical Clinic

We are pleased to welcome you as a new patient to our clinic. Our goal is to provide you with high quality, compassionate, and comprehensive medical care in a respectful and professional environment. To help us maintain a safe and efficient clinic experience for everyone, please review and acknowledge the following clinic policies:

New Patient Agreement

1. Respectful and Safe Environment

We have a zero tolerance policy for any form of verbal or physical abuse, threats, or disrespectful behaviour directed toward the physicians, clinic staff, or other patients. Any such behaviour may result in immediate termination of the patient-provider relationship.

2. Appointment Policy

If you are unable to attend your appointment, please provide at least 24 hours' notice. A fee may be charged for missed appointments or late cancellations, in accordance with the Doctors of BC guidelines. This fee is not covered by MSP.

3. Form Completion Eligibility

Forms such as those for ICBC, WorkSafeBC, disability, and other third-party documents will not be completed until you have been a patient at this clinic for at least three (3) months. This is necessary for the physician to establish an adequate understanding of your medical history and condition.

4. Shared Practice Model

Our clinic operates as a shared family practice between myself and my partner, who is also a family physician. Patients may be seen by either one of us depending on availability and clinic scheduling.

5. Additional Fees

Some services, such as forms, uninsured visits, and certain procedures, may not be covered by MSP and will incur additional fees, in alignment with the Doctors of BC recommended fee schedule. You will be informed of these fees prior to the service being provided.

6. Controlled medications including opioids and benzodiazepines

As part of safe prescribing practices, please note that while I may prescribe a small amount of opioids, benzodiazepines, or other controlled medications if I determine it is clinically appropriate, I cannot prescribe large quantities, especially if you are a new patient and I am not yet familiar with your full medical history. Any decisions regarding these medications will be made cautiously and in accordance with current medical guidelines and regulations.

7. AI Scribe for Documentation

To help us better listen and focus on you during your visit, we use a secure computer tool (AI scribe) to help write medical notes. This means the doctor can spend less time typing and more time paying attention to your concerns. The notes are checked by the doctor, and your personal information is kept private and safe. If you have questions or concerns about this, please let us know.

Acknowledgement

By signing below, I confirm that I have read, understood, and agree to abide by the policies outlined above. I understand that failure to comply with these terms may affect my ability to continue receiving care at this clinic. I understand that the physician I have selected will be my primary care provider and will coordinate my ongoing medical care, subject to availability.

Preferred Physician

Select your preferred physician:*

Preferred language of communication:

Additional comments or questions:

Full Name*

Signature*

Date (DD/MM/YYYY)*

1. Personal Information

First Name:*

Last Name:*

Preferred name (if different):

Gender/Pronouns:

Date of Birth (YYYY-MM-DD)*

Personal Health Number (PHN):

Address:*

Postal Code:*

Phone Number:*

Email Address:*

Occupation:

Family members (include full name and relationship):

2. Emergency Contact

Name:

Relationship to you:

Phone number:

3. Past Medical History

(Please check all that apply or write in any not listed)

Diabetes

Hypertension (High Blood Pressure)

High Cholesterol

Asthma

COPD / Emphysema

Heart Disease / Heart Attack

Stroke / TIA

Thyroid Disorder

Anxiety

Depression

Cancer:

Other mental health conditions:

Other:

4. Past Surgical History

(Please list any surgeries you've had including the year)

1. Surgery

Year

2. Surgery

Year

3. Surgery

Year

5. Medications

Prescription Medications (Include name, dose, and frequency):

Non-Prescription Medications / Supplements (e.g., vitamins, herbs, etc.):

6. Allergies

Drug Allergies (include your reaction):

Other Allergies (e.g., latex, food):

7. Family History

(List any major health conditions in family members)

Heart Attack – Family Member(s) Affected:

Diabetes – Family Member(s) Affected:

Cancer (specify type) – Family Member(s) Affected:

Stroke – Family Member(s) Affected:

Mental Health – Family Member(s) Affected:

Lung Condition – Family Member(s) Affected:

Other – Family Member(s) Affected:

8. Substance Use

Tobacco:

Never

Past user

Current user

Alcohol:

Never

Occasionally

Regularly

Cannabis:

Never

Past user

Current user

Other substances:

Never

Past use

Current use

9. Preventative Screening

(Please provide the most recent date and results, if known)

Pap Smear – Most Recent Date:

Result:

FIT Test (Stool Test) – Most Recent Date:

Result:

Mammogram – Most Recent Date:

Result:

Colonoscopy – Most Recent Date:

Result:

Bone Density Scan (DEXA) – Most Recent Date:

Result:

10. Immunizations

(Include most recent date if known)

COVID-19 — Date Received:

Influenza (Flu Shot) — Date Received:

Tetanus (Tdap/DTaP) — Date Received:

Pneumococcal — Date Received:

Shingles (Shingrix) — Date Received:

HPV — Date Received:

Other (specify):

Date Received:

Please bring a list of your current medications and any relevant records to your first appointment if available.

New Patient

Register as a New Patient

Available Physicians

Dr. Ali Ranjbaran

Dr. Leila Valaei

Dr. Chris Yoon

New Patient? Fill up the intake form

Welcome to Our Family Practice at Five Points Medical Clinic

New Patient Agreement

1. Respectful and Safe Environment

2. Appointment Policy

3. Form Completion Eligibility

4. Shared Practice Model

5. Additional Fees

6. Controlled medications including opioids and benzodiazepines

7. AI Scribe for Documentation

Acknowledgement

Preferred Physician

1. Personal Information

2. Emergency Contact

3. Past Medical History

4. Past Surgical History

5. Medications

6. Allergies

7. Family History

8. Substance Use

Tobacco:

Alcohol:

Cannabis:

Other substances:

9. Preventative Screening

10. Immunizations

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