DR FRANCES WANG ND
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  • Home
  • Medical Services
    • IV/ Injection Therapies
      • B12 / Energy Injections
      • Myers Cocktails
      • High Dose Vitamin C
      • Wellness IVs
    • Individualized Weight Loss
    • SIBO/ IBS Treatment
      • SIBO Preparation Phase
      • SIBO Eradication Phase
      • SIBO Maintenance Phase
    • Naturopathic Medicine
    • Heavy Metal Testing and Chelation Treatments
    • Craniosacral Therapy
    • Laboratory Testing
    • Prolotherapy
  • Patient Information
    • Intake forms
  • Meet the doctor
  • Blog
  • Recipes
  • Contact Us
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Naturopathic Intake Forms

For your convenience, you may download and print the one of the following intake forms prior to your first visit.
One is for adults (+12 years old) and one is for pediatric patients (under 12 years old).

If you are the parent/legal guardian of a child under 12 you may fill out the Pediatric Intake Form.

The IV intake form is for IV consults or mobile IV services only.

Please have these returned before your first visit to give me time to review your health conditions and fast track you to treatment. You can drop them off during office hours, or email them to drkcoombs@momentumhealth.ca .

​If you have current labs or imaging, please bring these with you to your first visit.


Thank you!
Naturopathic Adult Intake Form
File Size: 871 kb
File Type: pdf
Download File

Naturopathic Pediatric Intake Form
File Size: 804 kb
File Type: pdf
Download File

IV Consult Intake Form
File Size: 48 kb
File Type: pdf
Download File

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  • Home
  • Medical Services
    • IV/ Injection Therapies
      • B12 / Energy Injections
      • Myers Cocktails
      • High Dose Vitamin C
      • Wellness IVs
    • Individualized Weight Loss
    • SIBO/ IBS Treatment
      • SIBO Preparation Phase
      • SIBO Eradication Phase
      • SIBO Maintenance Phase
    • Naturopathic Medicine
    • Heavy Metal Testing and Chelation Treatments
    • Craniosacral Therapy
    • Laboratory Testing
    • Prolotherapy
  • Patient Information
    • Intake forms
  • Meet the doctor
  • Blog
  • Recipes
  • Contact Us