Register for Naturopathic and Lifestyle Medicine Clinic at Compassion Health Ottawa 2019!

Thank you for choosing Compassion Health 2019 Ottawa. We look forward to partnering together on a journey to wholeness.

Consistent with our firm commitment to practice whole-person, individualized care, we would like to get to know you better.  Please complete the form below for all new patients. The information you provide will help us understand you as a whole person and adequately address your health concerns.

Steps:

1. Please complete the form below to the best of your knowledge. Honesty is very important as we are not here to judge but rather to explore the best approach to take in your care.

2. After submitting the form, you may book an appointment online here. You may also walk-in on the clinic days as well. Clinic hours are: Tuesday August 13, 2019, 3:00 - 9:00 pm and Wednesday August 14, 2019, 11:00 am - 9:00 pm

Thank you in advance for taking time to complete this form as it is very comprehensive in nature. 


Name *
Name
Sex *
Phone number
Phone number
Address *
Address
Emergency Contact
Name *
Name
Phone *
Phone
Which services are you interested in? *
We treat patients using the following primary modalities: lifestyle medicine (nutrition, exercise, sleep, etc), botanical medicine, hydrotherapy, and clinical nutrition/supplements. We do not practice acupuncture based on the philosophy of traditional Chinese medicine, nor do we utilize homeopathy.
Interns *
Naturopathic medical school senior interns may be involved in the initial intake. All patient care will be supervised by our staff Naturopathic Doctor.
Medical Concern
Medical condition(s) *
Please write a history of the chief concern(s) including: when it started, current symptoms and treatments (including medications, supplements), what you hope to achieve through naturopathic care, and any other pertinent information you feel is necessary.
Please list past medical conditions and hospitalizations
Please list medical conditions in the family including: siblings, parents, and grandparents.
Diet category *
How many days a week are you doing structured physical activity?
My spiritual practices are
Best method of contact
Please indicate any other comments you feel are necessary for us when considering your case