book

New Patients

Parents must complete the following 6 forms prior to your child’s initial visit. If you are unable to download/complete these forms ahead of time, please arrive 30 minutes prior to the appointment time.

  1. Pediatric Intake Forms- Select Appropriate Ages
    • 0-12 months (PDF)
    • 1-3 years (PDF)
    • 4-10 years (PDF)
    • 10+years (PDF)
  2. Patient Information Form (PDF)
  3. Physician History Form (PDF)
  4. HIPPA
    • HIPPA Form (PDF)
    • Acknowlegement & Consent(PDF)
  5. Financial Policy Form (PDF)
  6. Insurance Form (PDF)

Established Patients

If your address, phone number, and/or email has changed, please bring the following updated information to your next appointment or mail it to us.

Records Release

If you would like to have your child’s records sent to the Children’s Naturopathic Centre from one of their other providers, please fill out the following form.

This form can also be used to have any/all records sent from the Children’s Naturopathic Centre to one of your child’s other providers.

Please ensure that you initial what records you would like sent.

Depending on the size of your child’s records, there may be a cost associated to sending the records. Please contact our office manager (Donna) to determine what this cost may be.