New patients are now being enrolled! We highly recommend enrolling with the digital intake form linked on this page. If you do not have access to technology, or want assistance with filling out the form, please call 519-728-9116 and request an “intake form assistance” appointment.
Before starting the digital form please gather the following information:
- Personal health history
- Family health history
- Immunization records
- Health Card
- List of medications
Helpful Tips:
- The form will take 10-20 minutes to complete depending on your health history.
- Information in the form is NOT saved if you close it before it is submitted so please gather what you need from the list above and set aside time to complete it in full.
- The demographic information at the top of the form is mandatory, all other fields we highly recommend you complete, but this information can be given at your first intake appointment if necessary.
New Patient Intake Form – Adult (18+)
New Patient Intake Form – Child (17 and under)
After the form is submitted you will be directed back to a page on this website that will give details on next steps.
