Patient Intake

The attached intake paperwork must be completed by the patient and submitted with the referral.

Click to download and fill out this editable form in your own time or use the online version below. Please do not use the SUBMIT button on these forms. They do not work in the downloaded version. 

Download the Pain Intake Form

Download the Cannabis Intake Form

 

The Online form is currently unavailable for maintenance. Please fill out the PDF form from the links above. 

 

Other intake forms you may be looking for at Rise BC Wellness Centre include the following;

Addictions Intake Form:  ORT_Intake

Massage Therapy Form: RMT Intake

Traditional Chinees Medicin/ Acupuncture Form: TCM intake 

At this time these forms are not editable on your computer. Please print and bring completed forms to your first appointment or arrive early to complete in the office.