Download and complete our new patient intake forms..

Patient Intake Forms

Our new patient intake forms can be downloaded below.  Please proceed as follows:

Click the download button below the intake form heading you wish to download.  The form will download to your computer’s DOWNLOAD folder as a PDF document.

The pdf form that was downloaded can then be saved/moved to a folder of your choice.  You can then open and complete the form on your computer by clicking in the highlighted areas and typing.

Once you have completed the form and saved it to your computer for future reference you can sent the form as an email attachment to one of the following:

    1. Cancer related intake forms: cancercare@integratedhealthclinic.com
    2. For all other intakes: admin@integratedhealthclinic.com

If you wish you can print the completed form and 1) bring it with you to your scheduled appointment, or 2) Fax to 604-888-8365.

 

If you have any questions bout this process, please give us a call at 604.888.8325.

Please note that the Aesthetics intake form cannot not be filled in electronically at this time. It will need to be printed, completed and scanned to email to be sent.

Appointment Cancelation Policy

Please be advised that a minimum of 24 hours notice is required for appointment cancellations, otherwise you will be responsible for payment of a cancellation fee of 50% of the service fee. No-Shows will be billed at 100% of the service fee.

Cancer Intake Forms

Cancer - New Patient Intake Form

Download

Cancer Screening & Prevention Program Intake Form

Download

Referral Forms

Cancer - Patient Referral Form

Download

IUD Referral Form

Download

General Health Intake Forms

Adult - New Patient Intake Form

Download

Youth - New Patient Intake Form

Download

Acupuncture - New Patient Intake Form

Download

Aesthetics - New Patient Intake Form

Download

OUR CONTACT INFO - FORT LANGLEY

VISIT IHC

Integrated Health Clinic
23242 Mavis Ave, Fort Langley, BC

CALL US

Ph: 604.888.8325
Fx: 604.888.8365

OUR EMAIL

Email from the Contact Us-Questions page.

OUR CONTACT INFO - WHITE ROCK

VISIT IHC

Integrated Health Clinic
Suite 101, 13585 16th Avenue, Surrey BC V4A 1P6

CALL US

Ph: 604.888.8325
Fx: 604.888.8365

OUR EMAIL

Email from the Contact Us-Questions page.