Patient Resources

What do you need for your First Appointment?

Before your appointment (if time permits), I am going to ask you to complete a few forms, and perhaps get a bit of information about yourself from your Medical Doctor/Allied Health Provider.

  1. Health History Questionnaire – please have this filled out to the best of your knowledge.  This form will take usually 5-10 min. to fill out.  You will be asked about personal information as well as a bit about your family’s health history.
  2. Patient Medication Summary Sheet – this form is to be used for any medications or supplements that you are currently taking or have recently been on (past 2 years).  Please do your best at getting the dosages and potency (strength) of the drugs.  This form can also be used to input your Health Supplements (ie. vitamin C).
  3. Diet Journal – please fill out 3-7 days of a Diet Journal.  The diet journal will be used to track the foods you eat, including any bowel movements, water, coffee, and exercise that you have in a day.  This information will help me find any nutritional deficiencies or food intolerances you may have; as well as help me track bowel frequency and hydration status.
  4. Informed Consent – This form is to be read fully, and signed/dated.  An informed consent is used to give you complete transparency with respect to treatments.  It outlines what my obligations to you the patient are.  Please read fully and sign/date
  5. Clinic Waiver and Policies – This form outlines the general policies around communications, payment of fees, fee schedule, and collection of extended health insurance information.

Thank you for your interest in Naturopathic Medicine.  One of the most important things a person can do is to take care of their health.  With today’s high stressed – no rest society, people are beginning to feel overwhelmed with all the processed foods and chemicals in the environment.  We often don’t think about taking care of our health until it is too late.  Naturopathic Medicine is an alternative and safe way of helping cleanse the body, strengthen the various organs, and rid the body of disease thereby promoting healing. 

I look forward to our meeting!   Please note that if there are any difficulties in completing the above forms, do not worry, as we can deal with these during your first visit.


Patient Questionnaires