Clinic Forms

Click to Download

New Patient Intake Form

Patients over the age of 18 now you can download and complete your intake paperwork prior to the consultation.  This allows us to maximize the allotted treatment time on creating your plan.

Pediatric Intake

For patient under 18 years of age.  Please complete with parent/guardian to the best of your ability prior to consultation.  This allows us to maximize the allotted treatment time on creating your plan.

Patient Consent Form

This form is to be completed by anyone seeking treatment at Headwaters Holistic Family Care.  Karen will carefully review it with you prior to signing during your first appointment.  It is available to download if you wish to review it before treatment.

 

215 First Ave E
Shelburne, Ontario
L9V 3J9
Located within Dr. Weinper's Shelburne Chiropractic Building

(226) 200-1393

©2019 by Headwaters Holistic Family Care. Proudly created with Wix.com