Welcome to Our Clinic – Patient Agreement

About Dr. Kamphuis

Dr. Andrew Kamphuis is a family physician with experience working in a wide range of clinical environments across Ontario. He is committed to providing patient-centered, efficient, and evidence-based care in a respectful and welcoming environment. With a special focus on accessible care, Dr. Kamphuis offers both scheduled appointments and walk-in availability to help meet the needs of all patients. He values preventive medicine, clear communication, and mutual respect as foundations of the physician-patient relationship.

We are pleased to welcome you to our family practice and walk-in clinic. To help us deliver efficient, safe, and high-quality care, we kindly ask that all new patients review and acknowledge the following clinic guidelines.

1. Walk-In Visits & Patient Volume Limits

• Walk-ins are welcome daily, depending on physician availability.
  
  

• While we strive to accommodate everyone, there may be rare days when clinic capacity is exceeded, and additional walk-ins cannot be accepted for safety reasons.
  
  

• Booking an appointment is encouraged whenever possible. Appointments guarantee you will be seen that day, unless the clinic is unexpectedly closed.
  
  

• While we do our best to stay on schedule, delays may occur due to the unpredictable nature of medical care. We appreciate your patience and understanding.
  
  

2. Appointment Etiquette & Visit Structure

• Appointment times are approximate and may vary depending on clinic flow.
  
  

• Knowing the reason for your visit helps us prepare and reduce wait times. Sometimes, we may not be able to address all concerns in one visit.
  
  

• Please focus on one concern per visit. If you have multiple concerns, we may ask you to return for a follow-up.
  
  

• Cancelling an appointment you no longer plan to attend is appreciated, but not mandatory.
  
  

• I try my best to stay on time, so sometimes a follow-up appointment will be the best way to ensure your concerns receive the attention they deserve.
  
  

3. Preventive Screening Guidelines

We encourage all patients to take an active role in preventive health. Please speak to your physician about:

• Colorectal Cancer: FIT test every 2 years after age 50
  
  

• Cervical Cancer: Pap test every 5 years after age 25 (if sexually active) – requires a dedicated visit or referral
  
  

• Breast Cancer: Mammogram every 2 years after age 50 (or earlier, starting at age 40, per Ontario guidelines)
  
  

If you have any questions, please ask. By signing this form, you acknowledge that you’ve been educated about these screenings and will request them when appropriate.

4. Prescription Renewals

• I will always prescribe enough medication to last until your next check-up. In some cases, I may need to see you more frequently as I get to know your health history.
  
  

• Please monitor your medication supply and plan ahead.
  
  

• Walk-ins for prescription renewals are always welcome.
  
  

• A $40 fee applies for prescription requests without an in-person visit.
  
  

• Routine and brief appointments are recommended for safe medication renewal.
  
  

• Controlled or complex medications may require more frequent monitoring.
  
  

5. Test Results & Specialist Referrals

• You will be contacted if results are abnormal or require follow-up. If you haven’t heard from us within two weeks, please call the clinic.
  
  

• Sometimes we may also contact you about normal results. If you have questions, you are welcome to walk in.
  
  

• Specialist referrals: Please wait two weeks before contacting the clinic to confirm processing. If you haven’t heard from the specialist, we can provide their phone number for follow-up.
  
  

6. Forms & Medical Records

• All forms (e.g., insurance, disability, school) require an in-person appointment to complete.
  
  

• We may request prior medical records. You’ll be asked to sign a release form.
  
  

• Some clinics charge a fee to send records. This fee is your responsibility.
  
  

7. Uninsured Services (Non-OHIP Covered)

Some services are not covered by OHIP. These include but are not limited to:

• Employment, school, or insurance forms
  
  

• Driver’s medicals
  
  

• Cosmetic procedures (e.g., skin tags, warts)
  
  

• TB testing
  
  

• Travel consultations
  
  

• Certain vaccines
  
  

• Non-OHIP mental health or dietitian services
  
  

• Third-party requested reports
  
  

A complete fee list is posted at the front desk.

8. Medications with Special Considerations

• We do not routinely prescribe narcotic or sedative medications, including:
  
  

• Opioids (Percocet, Tylenol #3, Oxycodone)
  
  

• Benzodiazepines (Clonazepam, Lorazepam, Diazepam)
  
  

• In exceptional cases, these may be prescribed with strict monitoring.
  
  

• Patients may be asked to sign a controlled substance agreement and complete drug testing.
  
  

• Unsafe use or non-compliance may result in discontinuation or dismissal from the practice.
  
  

9. Team-Based Collaborative Care

• Your care may involve medical students, residents, scribes, or other health professionals.
  
  

• When your physician is away, another qualified provider may assist in your care.
  
  

10. Respectful Conduct

• We strive to maintain a respectful, inclusive, and safe environment.
  
  

• Verbal abuse, harassment, or aggression toward staff or others will result in dismissal.
  
  

• Please keep your contact and health information up to date.
  
  

11. Office Policies

• Disputes over clinic policies or repeated inappropriate behavior may result in termination from the practice.
  
  

• Threats of unfounded complaints to regulatory bodies (e.g., CPSO) will also result in termination.
  
  

• If you choose to leave the clinic, we will assist with record transfers for a nominal administrative fee.
  

12. Visit Policies

• All visits are in-person. Home visits are not offered.
  
  

• Phone visits may be conducted at the physician’s discretion for simple issues.
  
  

• You are free to attend other clinics. If tests are ordered elsewhere, please bring a copy before following up.
  
  

• As per OHIP policy, the person being discussed must be physically present at the visit.
  
  

• Visits may be brief, but follow-up visits are welcome.
  
  

• While we strive to maintain a diverse team of professionals, we encourage patients who are not fluent in English to bring a translator with them for their visit to ensure clear communication
  
  

To help us prepare, please consider:

• What brings you in today?
  
  

• How would you like the doctor to help?
  
  

• When did your issue begin?
  
  

• Were there any triggers?
  
  

• What treatments have you tried?
  

13. Use of AI Scribe for Documentation

• We may use an AI scribe tool to help document your visit. This improves physician efficiency and quality of care.
  
  

• No identifying information is saved, and all data is deleted after entry into your chart.
  
  

• You may opt out at any time, including on a visit-by-visit basis, by informing the physician.

Patient Acknowledgement

I have read and understood the clinic’s policies. I agree to follow these guidelines and understand that failure to comply may result in a review or termination of my care at this practice.

Patient Name: ____________________________________
Signature: ________________________________________
Date: ____________________________________________