When completed, please return to office by mail or fax. Upon receipt of history form, you will be contacted regarding an initial appointment.
*I require a formal referral from your Family Physician or General Practitioner
-and shall dictate a consultation report to the referring physician
**copies of recent or significant lab investigations, X-ray reports, and specialist consultation reports are very helpful
Download the History Information form :
Click here
Fill out the History Information Form Online