Get Canada Pure Wellness Group Injection Therapy Health Screening Form 2022-2025

This guide provides clear instructions for users on how to complete the Canada Pure Wellness Group Injection Therapy Health Screening Form online. It is designed to assist you through each section, ensuring a smooth and efficient process.

Follow the steps to complete the health screening form online.

1. Click ‘Get Form’ button to access the Injection Therapy Health Screening Form and open it in your preferred editor.
2. Begin with the general information section, where you will need to input your date, name, date of birth, gender, address, home phone, work phone, cell phone, email address, occupation, how you heard about the clinic, family physician, and their phone number, along with any other health care providers and their contact numbers.
3. In the medical history section, list any current medications or supplements you take, including the type, dose, and date started. Document any surgeries or injuries with the respective dates.
4. Proceed to the medical testing section by detailing any preventative or exploratory tests you have completed in the last five years. Include the type of test and the results. Additionally, list all allergies and sensitivities related to food, medications, or environmental factors.
5. Complete the cardiovascular and respiratory sections by checking any relevant medical conditions you may have experienced, such as high blood pressure or asthma.
6. Describe any aches and pains you may have experienced in the designated area, addressing any gastrointestinal, immune, renal, or urology concerns thoroughly.
7. Fill out the family history section, noting any hereditary health issues present in your family, including autoimmune diseases and cancer.
8. If you are pregnant, please provide your due date in the indicated field.
9. Review the fee structure for naturopathic visits, acknowledging that different appointment durations have different costs.
10. Carefully read the informed consent section regarding intravenous or injection therapy, ensuring you understand the risks and benefits. Sign and date where indicated.
11. Complete the patient information and privacy form, signifying your consent to the collection and use of personal information as per the privacy policies outlined.
12. Finally, make sure to sign the patient pledge, affirming your commitment to the treatment process.
13. Once you have filled out all sections, you can save any changes, download, print, or share the completed form as needed.

Complete your Canada Pure Wellness Group Injection Therapy Health Screening Form online today for a healthier tomorrow.