OUR Patient Forms

New Adult Patients

health_assessment_questionnaire.pdf
File Size: 60 kb
File Type: pdf
Download File
health_history.pdf
File Size: 1542 kb
File Type: pdf
Download File

New Child Patients

pediatric_intake_form.pdf
File Size: 1209 kb
File Type: pdf
Download File

Other Forms

detox_questionnaire.pdf
File Size: 40 kb
File Type: pdf
Download File
These forms can be downloaded by clicking on the form names. The forms can take up to one hour to fill out. They provide us with important information needed for the complete assessment of your health situation.   

Serving Kitchener, Waterloo, Cambridge and Surrounding Area.