Patients looking for a new doctor

We do NOT assess for ADHD, NOR do we prescribe stimulants/narcotics (e.g. for ADHD or chronic pain)

Name (Exactly as it appears on your Healthcard)

Gender

Date of birth (EXACT FORMAT: YYYY-MM-DD)

Phone (ideally cell number)

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Healthcard details (10 numbers e.g. 0123456789 AND 2 letters e.g. AB)

List of previous/current medical conditions and operations (e.g. depression, sinus surgery)

List of current regular medications with dosing (e.g. Eltroxin 50mcg once daily)

Weight in kilograms

Height in centimetres

How did you hear about us?