Forms - Living Wellness 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Information. Fill in the date, full name, preferred name, birthday, age, home address, city, postal code, primary telephone, cellphone, and email.
3. Indicate your preference for appointment reminders by selecting either text or email. Provide your cellphone provider if you chose text reminders.
4. List the name and telephone number of your General Practitioner (MD) and an emergency contact along with their relation to you.
5. In the Health Issues section, detail any medications (prescription or over-the-counter), supplements, and therapies you are currently using.
6. Review the Counselling Declaration & Consent to Treatment section carefully. Ensure you understand the benefits and risks outlined before signing.
7. Finally, sign and date the form at the bottom to confirm your consent and understanding of the information provided.

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