Patient Intake

Dr.Kailia is not accepting any new referrals at his office in Nelson at this time. He is accepting new referrals at Empower Health in Vancouver.   Please have your family doctor fax us a referral to (778)463-4999.

The 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


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

Opioid Replacement Therapy Form:  ORT_Intake

Massage Therapy Form: RMT Intake

Traditional Chinees Medicin/ Acupuncture Form Andrea Wilson: 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.