Welcome to Gambit’s Executive Health Intake Form. We are happy to have you join our premiere Executive Health Membership. Please kindly have ready the pictures of the below items:

  • Provincial Health Card (front and back)
  • Driver’s License or another government-issued ID
  • Recent selfie of your face

By proceeding, you:

  • agree to our privacy policy and terms and conditions.
  • 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 any prescription medication you currently take and any serious illnesses or surgeries you have had.

Please make sure to fill out the form to your best knowledge. Get Gambit is not liable for any causes that may occur from the non-disclosure of any information.

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