Patient Forms

Please download and complete the gender appropriate intake form. Once completed, you can click the ‘submit’ button at the bottom of the questionnaire, and it will be sent to us via email.

It is important that you complete this form to the best of your ability before your scheduled consultation, so that you and the doctor can accomplish all that is required within a 60 minute appointment. It is also important that you complete all questions on the questionnaire to help the doctor become familiar with your medical history.

When all of the information is gathered, we use a combination of seminars, reading materials, allied team members, and physicians advice to arrive at your personalized health plan.

If you have any questions about how to complete these forms, please contact us.

t: 604.569.0488
f: 604.229.2088
e: info@balancemedical.ca

Female Patient

Intake Questionnaire

Download

Male Patient

Intake Questionnaire

Download