Please, complete all applicable forms prior to arriving for your first visit. Do not hesitate to contact us if you have any questions.
Kayla Adebajo, NP-PHC, PhD (cand.) INTAKE FORMS – 16 pages
Annette Stutzki, RN (EC) NP-PHC INTAKE FORMS – 9 pages
HEIDELBERG QUESTIONNAIRE – 5 pages
The Quick Power Up IVs don’t require an hour consultation with our Nurse Practitioner. An intake form is required for your visit to show that no contraindications are present. Please print, fill it out and bring this intake questionnaire with you if you are:
- a new patient
- there were any changes to your health since the last visit
- you were having an IV longer than 2 months ago
INTRAVENOUS (IV) INFUSION THERAPY INTAKE AND MEDICAL HISTORY FORM – 2 pages
New Patients Intake
Welcome and thank you for choosing our clinic in your quest for optimum health. We are committed to delivering excellent healthcare service. We will do all we can to meet your health needs.
PLEASE REFRAIN FROM USING ANY SCENTED PRODUCTS WHEN VISITING THE CLINIC: PERFUMES, SHAMPOOS, AFTERSHAVES, CREAMS, LOTIONS, DEODORANTS, SOAPS and LAUNDRY DETERGENTS.
Please DO NOT BRING ANY PETS to the clinic. Many of our patients suffer from severe environmental allergies and this is for their protection.
Please let us know if WHEELCHAIR ACCESS is necessary, so we arrange any help needed to enter the building.
INITIAL VISIT
1) Meet with the staff and hand in the completed intake forms.
2) Weight, height and blood pressure readings are taken.
3) Completing any forms that have not been finished and sign the required consents.
4) Blood may be taken for various blood tests as ordered by your practitioner.
5) Body Composition (BIA) test may be performed.
6) Discussion of any health problems and an initial treatment program will be composed. This program might include supplements and intravenous treatments. Additional tests may be prescribed at that time.
PREPARATIONS FOR THE BIA TEST
If the BIA test is requested by your practitioner, the following PRE-TEST BIA PREPARATION should be followed:
- No alcohol consumption for 24 hours
- 2-4 glasses of water within 2 hours of a visit
- No exercise, caffeine or food for 4 hours prior to arrival
PAYMENT FOR SERVICE
The cost of the counselling is the responsibility of the patient. TAX and INSURANCE forms are available upon request. Private Insurance may cover some of the costs of Naturopathic Doctors visits.
The preferred method of payment is cheque, cash or debit. If payment is by cheque, it is payable to Preventimed. Credit card required upon booking.
PAYMENT IS DUE AT THE TIME OF THE VISIT. Prices are subject to change without notice.
APPOINTMENTS REMINDERS
Two business days before your visit, a receptionist will phone with a reminder for a booked appointment. Please reply to her message.
The patient/client is ALWAYS responsible to call 48 hours prior to the scheduled appointment time to reschedule or cancel.
LATE CANCELLATION CHARGES AND MISSED APPOINTMENTS (NO SHOW)
If you are not able to make your appointment as scheduled, your practitioner needs to know in advance so that other patients who are waiting for an appointment can be contacted.
If a late cancellation/rescheduling made within the 48-hour period (less than two business days notice is given) the following charges are applied:
- $150 for a new patient/client visit
- $75 for a follow-up visit
If you missed an appointment (didn’t show up) without any notice, the full appointment fee will be charged to you. It will depend on who an appointment was with as our practitioners have different fees.
LABORATORY TESTS RESULTS
Our practitioners review all laboratory tests results on a regular basis. You will be contacted only if your lab test results are of an urgent nature.
E-MAIL COMMUNICATION
E-mails will be acknowledged in a timely fashion. However, we do not monitor e-mails when the practice is closed for weekends, evenings, statutory holidays, and vacations. Please consider our office hours when you are waiting for a reply to your e-mail.
As a general rule, we will respond to patient e-mail within 72 hours. If you do not receive a response within the designated time period, please call the office to follow up.
Our practitioners will not respond to questions pertaining to your health over email. If you have any questions or concerns over your care, you will have to schedule an appointment. Please telephone (416)463-2911 for an appointment.
If the matter is urgent, please visit your nearest hospital or an urgent care centre.
PRIVACY, CONFIDENTIALITY AND INFORMATION SECURITY
Please ensure that you are using the e-mail address that has been provided by this medical practice; we are not responsible for e-mails sent to the wrong e-mail address.
When communicating with this medical practice by e-mail, you are strongly advised to use your own personal computer and to use an e-mail address that is password-protected and that only you can access (for example, not at work).
It may be necessary for the office staff or other practitioners to access e-mail from patients in the course of their duties. Be assured that they will respect your privacy and will keep your personal information confidential.
If you are uncomfortable in any way about communicating electronically with this medical practice, please call for an in-office appointment.
If you subscribed to our E-mail Newsletter and no longer wish to receive it, you can withdraw your consent at any time. Please let us know by using one of the following methods: by telephone, by mail, in person, by e-mail or clicking on the “unsubscribe from this list” link at the bottom of the E-mail Newsletter and following the instructions.
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ADMINISTRATIVE CHARGES
COPYING/ TRANSMISSION OF MEDICAL RECORDS (WHEN NOT MEDICALLY NECESSARY), SUM OF
- Copying – $35 (first 20 pages) + $0.30 per page thereafter
- Out-of-pocket disbursements (where applicable) – at cost
- Physician review of records – Physician’s hourly rate