Our forms are now online and easy to fill out! They will be emailed directly to us upon completion. Thank you for choosing Eastern Therapies. We look forward to meeting you!
Please carefully choose the form that best suits your concerns and fill out one form only.
General Health Form: for any physical, mental, or emotional conditions, such as chronic or acute illness, injury, or stress. If you are coming for natural fertility, IVF, or are pregnant/ have pregnancy-related concerns, please do not use this form and choose one of the other forms below.
Confidential New Patient Intake Form: General Health
Pregnancy Form: for current pregnancy related conditions or labour preparation treatment.
Confidential New Patient Intake Form: Pregnancy
Female Natural Fertility Form: for natural conception assistance.
Confidential New Patient Intake Form: Female Natural Fertility
Female IVF or IUI Form: assisted conception patients
Confidential New Patient Intake Form: Female IVF or IUI
Male Fertility Form: for natural or IVF/IUI
Confidential New Patient Intake Form: Male Fertility
Pediatrics Form: for children 0-12 years of age
Confidential New Patient Intake Form: Pediatric General Health Age 0-12 years
Facial Rejuvenation Form: Confidential New Patient Intake Form: Facial Rejuvenation
Post Birth Questionnaire: If you have recently given birth after coming to us for labour preparation treatments, we would like to know more about your birth experience! Please fill out this brief survey to help us to better assist our pregnant clients.
Post Birth Questionnaire
Quick Form (office use only) General intake form
Goals for Your Health – New patients: Goals for Your Health
Goals for Your Health – Returning patients: Goals for Your Health – Returning Patients