Forms

 

 

Please download, print and fill out forms prior to your first visit and bring them with you. This will decrease the amount of time in our waiting room. You can fill out the PDF forms online by using Adobe. 

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New Patient Intake Form (front)

New Patient Intake Form (back)

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New ICBC Intake Form (front)  *for all new ICBC claims, regardless if you've been in for treatment already

New ICBC Intake Form (back)  *for all new ICBC claims, regardless if you've been in for treatment already

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Self Assessment Questionnaire (no need to fill anything out)

Please ask yourself and answer these questions before attending your appointment:

1. Do you have a fever, new cough, worsening chronic cough, shortness of breath or  difficulty breathing?

2. Have you travelled outside of Canada in the past 14 days, and have been told to quarantine?

3. Do you have a confirmed case of COVID-19, are you awaiting the test results for COVID-19, or come in close contact with someone with COVID-19?

4. Do you have 2 or more of the following symptoms: sore throat, runny nose/sneezing, nasal congestion, hoarse voice, difficulty swallowing, decrease/loss of sense of smell, chills, headache, unexplained fatigue/malaise, diarrhea, abdominal pain, nausea/vomiting?

5. If you are over 65, are you experiencing: delerium, falls, acute functional decline, or worsening chronic conditions?

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If you answered YES to any of the screening questions, please call/email the clinic to reschedule your appointment.