Roots To Health Naturopathic Clinic
778-481-5008
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Intake Forms


Please fill out as thoroughly as possible and either email (Dr. Chris Ford - drford@roots-to-health.com or Dr. Darcie Pawlick - drpawlick@roots-to-health.com) or fax (778-481-5009) them back to us or print it out and bring them to your initial visit.  

Note: Please save the form to your computer desktop BEFORE filling it out in order to save it after it has been completed. If you have any questions please contact us.

Adult Intake Form

Roots to Health Intake Form - Adult
File Size: 183 kb
File Type: pdf
Download File

Child Intake Form - 12 and under

Roots to Health Intake Form - Child
File Size: 217 kb
File Type: pdf
Download File

Adult and Child Consent Form

Roots to Health Consent Form
File Size: 132 kb
File Type: pdf
Download File

Acupuncture Intake Form

Roots to Health Intake Form - Acupuncture
File Size: 76 kb
File Type: pdf
Download File

Acupuncture Consent Form

Roots to Health Consent Form - Acupuncture
File Size: 132 kb
File Type: pdf
Download File

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To download Adobe Reader please click here.
> About Our Doctors and Staff
> Principles of Naturopathic Medicine
> Therapies We Use
> Health Care Coverage
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> About Your Visit
> Patient Forms

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'Natural forces within us are the true healers of disease' - Hippocrates