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!
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 |
| Naturopathic Pediatric Intake Form |
| IV Consult Intake Form |