Axion Integrated Health
New Patients

Patient Forms

Please complete the intake form and informed consent form before your first appointment. Completing these forms in advance helps our clinical team prepare for your visit and ensures we can provide you with the best possible care.

Your health information is private and kept confidential in accordance with applicable privacy legislation.
Step 1 of 2

Patient Intake Form

This form collects your personal information, medical history, current symptoms, medications, lifestyle factors, and treatment goals to help our clinical team prepare for your assessment.

  • Personal & contact information
  • Insurance / claim details
  • Pain history & concerns
  • Medical history & medications
  • Lifestyle & mental health
  • Consent to proceed
Step 2 of 2

Informed Consent Form

This form outlines the nature of services provided at Axion Integrated Health, including potential benefits, material risks, alternatives, privacy practices, and your rights as a patient.

  • Nature of services provided
  • Consent to assessment & treatment
  • Potential benefits & risks
  • Privacy & health information
  • Electronic communication preferences
  • Acknowledgement & signature

Having trouble completing these forms? Please contact our clinic directly and we will be happy to assist you. (905) 000-0000 or admin@axionintegratedhealth.com