Traditional Chinese Medicine forms
Chiropractic Care
The following forms are used in relation to chiropractic care at Achieve Health. If you have any questions about any of the forms, please feel free to contact us about them or ask Dr. McIlmoyle during your visit.
- Consent Form (PDF)
- This is the consent form you will need to sign prior to initiation of chiropractic treatment.
- Office Policy/Fee Schedule (PDF)
- This form lists the fees for initial and subsequent chiropractic visits, as well as fees for emergency visits and house calls (yes, Dr. McIlmoyle does house calls!)
- Chiropractic Intake Form (PDF)
- This is the form you will fill out prior to your first visit with Dr. McIlmoyle. It includes your contact information, medical history, behaviour patterns and other relevant information that will help Dr. McIlmoyle understand your current health status. We have copies of this form at the office, but if you wish, you can print out a copy, fill it in ahead of time and bring it with you on your first visit.
- Pain Diagram (PDF)
- This is the form where you "tell us where it hurts". The form uses different symbols to display different types of pain. Dr. McIlmoyle will be happy to help you fill in this form if you find the pain difficult to describe.
Naturopathic Medicine forms
The following forms are used in relation to naturopathic medicine at Achieve Health. If you have any questions about any of the forms, please feel free to contact us about them or ask Dr. O'Neill during your visit.
- Consent Form (PDF)
- This is the consent form you will need to sign prior to initiation of naturopathic medicine treatment.
- Naturopathic Rates (PDF)
- This form lists the rates for the various naturopathic medicine services Dr. O'Neill offers.
- Naturopathic Intake Forms
- Intake forms for naturopathic medicine include your contact information, medical history, behaviour patterns and other relevant information that will help Dr. O'Neill understand your
current health status. We have copies of these forms at the office, but if
you wish, you can print out a copy of the relevant form, fill it in ahead of time and bring it with you on your first visit:
Adult Intake Form (PDF) - Fill out this intake form when the patient seeking treatment is an adult (19 years and older).
Infant/Child Intake Form (PDF) - Fill out this intake form when the patient seeking treatment is a child or infant (under age 19).
Massage Therapy forms
The following forms are used in relation to massage therapy at Achieve Health. If you have any questions about any of the forms, please feel free to contact us about them or ask Eric during your visit.
- Consent Form (PDF)
- This is the consent form you will need to sign prior to initiation of massage therapy.
- Massage Therapy Rates (PDF)
- This form lists the fees for massage therapy treatment sessions, which vary depending on the length of the session.
- Massage Therapy Intake Form (PDF)
- This is the form you will fill out prior to your first visit with Eric Purves. It includes your contact information, medical history, behaviour patterns and other relevant information that will help Eric understand your current health status. We have copies of this form at the office, but if you wish, you can print out a copy, fill it in ahead of time and bring it with you on your first visit.
- Pain Diagram (PDF)
- This is the form where you "tell us where it hurts". The form uses different symbols to display different types of pain. Eric will be happy to help you fill in this form if you find the pain difficult to describe.
Traditional Chinese Medicine forms
The following forms are used in relation to traditional Chinese medicine and acupuncture at Achieve Health. If you have any questions about any of the forms, please feel free to contact us about them or ask Michael during your visit.
- Consent Form (PDF)
- This is the consent form you will need to sign prior to initiation of your traditional Chinese medicine/acupuncture treatments.
- Traditional Chinese Medicine Rates (PDF)
- This form lists the fees for traditional Chinese medicine visits and acupunture treatments.
- Traditional Chinese Medicine/Acupuncture Intake Form (PDF)
- This is the form you will fill out prior to your first visit with Michael Cote. It includes your contact information, medical history and other relevant information that will help Michael understand your current health status. We have copies of this form at the office, but if you wish, you can print out a copy, fill it in ahead of time and bring it with you on your first visit.