Register for Naturopathic Care

Our naturopathic physicians provide family health care with an emphasis on diet, nutrition and natural therapeutics, which includes acupuncture, diet therapy, IV nutrients, hormone replacement therapy, acupuncture and much more.

Your initial appointment is 45-60 minutes. Please bring any medical records (medications, lab work). Naturopathic medicine is covered by most extended health insurance carriers. We bill directly for many extended care plans.

To schedule an appointment with our Naturopathic physicians and begin your journey to better health, please fill out this contact form and contact our office at 604-575-7275.

First Name

Last Name

If less than 18 years old, what are parent's names?

Do you have another first name you go by?

Date of birth

Day of birth DD

Month of birth MM

Year of birth YYYY

Care card number

Email Address

Primary Phone Number

Secondary Phone Number (optional)

Street Address

City

Postal Code

Present Health Concerns

Medical History - Please list any health concerns, past and present (for example: cancer, depression, anxiety, hypertension, asthma,...)

Surgeries, hospitalizations or injuries/accidents (year and description)

Family Medical History (list condition and family relation)

Children (number and age)

Allergies (include medicines, pollens, animals, foods, and chemicals)

Current Medications (name and dose of prescription medicines, over the counter medicines, and supplements)

How did you hear about us?

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Is there anything else you would like us to know? (optional)

Missed or rescheduled appointments with less than 48 hours notice will result in a charge for the full cost of the missed appointment. Payment for services, ie. consultations, lab procedures and medical therapy, is due at the time service is rendered. Medications may be returned within 7 days of purchase only if undamaged and sealed; compounded medications are final sale. The patient acknowledges that any medical treatment has potential risks and side effects and consent to treatment. I understand the terms and conditions as stated above.

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