New Patient Intake Form Instructions

Complete the Form:
Please fill out the intake form and bring a physical copy to the clinic during business hours.
Individuals Over 12:
Each person over the age of 12 must complete their own individual intake form.
Children Under 12:
If the child does not have relevant medical history, simply write their name, date of birth, and PHN (Personal Health Number) on the parent's form. If there is relevant medical history, please complete a separate form for the child.

**Due to high patient volume, please refrain from asking about wait times. We are doing our best to accommodate everyone and appreciate your patience.

New Patient Intake Form Instructions

Complete the Form:
Please fill out the intake form and bring a physical copy to the clinic during business hours.

Individuals Over 12:
Each person over the age of 12 must complete their own individual intake form.

Children Under 12:
If the child does not have relevant medical history, simply write their name, date of birth, and PHN (Personal Health Number) on the parent's form. If there is relevant medical history, please complete a separate form for the child.

New Patient Intake Form Instructions

Complete the Form:Please fill out the intake form and bring a physical copy to the clinic during business hours.

Individuals Over 12:Each person over the age of 12 must complete their own individual intake form.

Children Under 12:If the child does not have relevant medical history, simply write their name, date of birth, and PHN (Personal Health Number) on the parent's form. If there is relevant medical history, please complete a separate form for the child.

Complete the Form:
Please fill out the intake form and bring a physical copy to the clinic during business hours.

Individuals Over 12:
Each person over the age of 12 must complete their own individual intake form.

Children Under 12:
If the child does not have relevant medical history, simply write their name, date of birth, and PHN (Personal Health Number) on the parent's form. If there is relevant medical history, please complete a separate form for the child.