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CLIENT INTAKE FORMS

• naturopathy

  • Adult Intake Forms

    Please print and complete all forms below to be brought in with you on your first Naturopathic Visit.
    Adult Intake Form (click for pdf) Consent to Services & Privacy (click for pdf) Informed Consent (click for pdf)
    

    Pediatric Intake Forms

    Please print and complete all forms below to be brought in with you on your first Naturopathic Visit.
    Pediatric Intake Form (click for pdf) Additional Section for Adolescents ONLY (click for pdf) Consent to Services & Privacy (click for pdf) Informed Consent (click for pdf)
    
    

    Fertility Intake Forms

    Please print and complete all forms below to be brought in with you on your first Naturopathic Visit. Note that you do NOT have to fill out an adult intake form in addition to the 'Fertility Intake Form'
    Fertility Intake Form (click for pdf) Consent to Services & Privacy (click for pdf) Informed Consent (click for pdf)
    

• holistic health

  • Complete Holistic Health Assessment

    Please print and complete the form below to be brought in with you on your first Holistic Health Visit.
    Holistic Health Intake Form (click for pdf)
    

    Reflexology

    Please print and complete the form below to be brought in with you on your first Reflexology Visit.
    Reflexology Intake Form (click for pdf)
    

    Reiki

    Please print and complete the form below to be brought in with you on your first Reiki Visit.
    Reiki Intake Form (click for pdf)
    

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