Intake  Form

Save time at your assessment by filling out the following intake form!

Note: IF YOU DO NOT GET A "THANK YOU" CONFIRMATION at the end of the form after you submit, YOUR INTAKE FORM WAS NOT SUBMITTED PROPERLY!

You will be asked to redo the intake form in clinic if you did not submit the intake form properly. You can always call our clinic to verify that we received your intake form if you are unsure.

This intake form submission adheres to the Personal Health Information Protection Act (PHIPA).

Having trouble viewing the intake form on this page? Click here