Intake Forms

Naturopathic Medicine:

Please consider filling out the appropriate INTAKE FORM and REVIEW OF SYSTEMS so that we can better understand the nature of your health concerns. Treatments provided are specific to your individual health and will be explained before having you fill out the informed consent forms.

Your first initial consult is scheduled for 75 minutes, allowing ample time to understand your health concerns and health goals. Length of follow-up appointments will depend on the nature of the complaint and treatment plan. Treatment may include any of the naturopathic modalities, including: diet and lifestyle counselling, acupuncture, botanical therapies, homeopathic preparations, among several other therapies. We will work with you to create a manageable and sustainable treatment plan that addresses your health goals and priorities.

Adult

 Adult Intake FormDownload Adult Intake Form
 Review of SystemsDownload Review of Systems Form
Gynecologic Intake FormDownload Review of Systems Form
Breastfeeding Intake FormDownload Review of Systems Form

Pediatric

 Child Intake FormDownload Child Intake Form
 Review of SystemsDownload Review of Systems Form

Massage Therapy:

 Massage Intake Form pg 1Massage intake form page 1
Massage Intake Form pg 2Massage intake form pg 2

Holistic Nutrition:

 Client Lifestyle Assessment Form
Massage intake form page 1

Physiotherapy:

Physiotherapy Intake Form
Massage intake form page 1

Counselling:

Carolyn Higginson, MSW, RSW
 Counselling Intake Form Massage intake form page 1
Referral Form Massage intake form pg 2

Counselling:

​Sara Coyle, MSW, RSW
 Child Dyadic Intake FormMassage intake form page 1
Adult Individual Intake FormMassage intake form page 1

Counselling:

Alma McNairn, MSW, RSW
 Intake FormMassage intake form page 1

Counselling:

Kate Moebus, MCP, RP
Intake FormMassage intake form page 1

Counselling:

Margarida Medeiros, BSW (Hons), RSW
 New Client Intake Form Massage intake form page 1