Medical form (new patient)
Are you a new patient?
You must first complete a form collecting details about your condition before your first appointment at the clinic. To speed up the process, we invite you to fill out this form at home:
Download the form (PDF) by clicking here
Save the form on your computer before filling it *DO NOT COMPLETE DIRECTLY IN YOUR WEB BROWSER
Fill out and print the form.
Bring the form to the first appointment OR
Email it to firstname.lastname@example.org
In case of cancellation of an appointment, please notify us by phone or email at least 48 hours in advance, otherwise you will have to pay a service fee.