Answer a short questionnaire and a licensed health provider will assess your intake within 24 hours. Your progress is automatically saved.
Your treatment charge will be confirmed after the licensed health provider has completed your consult.
Please answer this form to your best ability.
You will be required to upload the following. Please have them ready for faster completion of the intake questionnaire:
– Government ID
– Provincial health card
– Private insurance card (if any)
By clicking “Let’s Begin”, you are confirming that you:
• Are completing this form for yourself and will answer the questions accurately and completely to your best ability
• Will disclose and consent to have stored the information of medical health information.
• Understand that weight loss treatments is a last resort for when alternative means have proven ineffective.
Weight is first managed by maintaining a healthy diet and a regular exercise routine as well as reducing stress and ensuring adequate sleep. Weight gain may also be caused by metabolic and vascular diseases such as diabetes or atherosclerosis. By proceeding with the intake form, you accept any risks involved in the consultation, diagnosis and treatment regime for any contributing conditions and in the treatment regime we prescribe. We strongly recommend you have your primary care provider assess you for the possibility of preexisting conditions prior to using our service.