Get Canada Family Physiotherapy Centre Of London Client Intake Form 2015-2025

Completing the Canada Family Physiotherapy Centre Of London Client Intake Form online is a straightforward process designed to gather essential information about your health and wellness. This guide will walk you through each section of the form to ensure that you provide all necessary details accurately.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Client Intake Form and open it in the designated format.
2. Begin by providing your personal information. Enter your name, date of birth, address, and contact details, including your main and cell phone numbers, and email address. This information is vital for your records and communication with the clinic.
3. Indicate how you heard about the Canada Family Physiotherapy Centre Of London. This assists the clinic in understanding their outreach effectiveness.
4. In the medical information section, describe your reason for referral, detailing any concerns or symptoms you are experiencing. Be as specific as possible to help the healthcare provider understand your situation.
5. Provide the name, address, and contact information for your family doctor. This information is important for the clinic to coordinate your care.
6. List any medical history or complications you have experienced, alongside your family's health history, which helps identify any hereditary conditions.
7. Detail your current medications, vitamins, or supplements you are taking, along with any known allergies. This can help avoid potential adverse reactions.
8. Fill in your height, weight, and ideal weight to give the clinic a better understanding of your physical condition.
9. Check any chronic conditions you have experienced from the provided list. If your condition is not listed, specify it in the space provided.
10. In the diet and lifestyle section, indicate if you have previously consulted with a Registered Dietitian. Describe your experience if applicable.
11. Rate your stress level over the past week on a scale of 1 to 10, and describe how you manage stress. This information will help tailor your nutritional and wellness plan.
12. Indicate your physical activity level, occupation, and any barriers you face in achieving your health and nutrition goals.
13. Provide details about your eating habits, including meals and snacks consumed, types of beverages you drink, and your overall meal preparation preferences.
14. Read and understand the informed consent section thoroughly. Acknowledge that the services provided are not meant to replace medical advice and that you must manage your own health decisions.
15. Sign and date both the informed consent and cancelation policies to agree to the clinic's terms and conditions.
16. Finally, once all fields are completed, you can save your changes, download, print, or share the form as needed.

Complete your Client Intake Form online today to start your journey towards improved health and wellness.