For therapeutic services, please read before completing the Intake and Service Option Form.
– 3:1 Therapeutic Ketogenic Diet, please read this page.
– 2:1 Therapeutic Ketogenic Diet, please read this page.
– MCAS, hEDS, or POTS, please read this page.
OPTION A: (Book Online)
Complete the Intake and Service Option Form Online
- All services we provide are listed on the form, along with their respective costs (GST-exempt).
- Only the first 2 pages of the form need to be completed, and the last page needs to be signed and dated. Please remember to select the service(s) you want from the other pages.
- Drag and drop a copy of your most recent lab test results right onto the form, or send them to our office later.
- You will be able to download a copy of the completed form for your records.
- If you would like to download a copy of the form before completing it online, please see below.
Complete the Intake and Service Option Form to get started, and remember to click “SUBMIT” to send it. You will receive a confirmation message.
OPTION B: Book via Email or Fax
Complete the Intake and Service Option Form Manually
1. Download the Intake and Service Option Form
The first step would be to download the Intake and Service Option Form (dated April 15, 2026) to your computer.
All services we provide are listed on the form, along with their respective costs (GST-exempt).
Note: If you want a password-protected form, please email our office (email address is on the regular Intake and Service Option Form).
2. Complete the Form
The second step would be to complete all the boxes on the form on your computer, tablet, or smartphone using ordinary sentence case (not all capitals or lower-case). For a Windows device, use the free Adobe Online tool, or for a Mac device, use Preview.
Note: Only the first 2 pages of the form need to be completed; the last page must be dated and signed. Select the service(s) you want from the other pages
Need help? Step-by-Step Instructions here.
3. Email or Fax Your Documents
The third step is to email your completed Intake and Service Option Form to the address on the first page.
- Please be sure all boxes are completed
- Please do not scan the form before sending it, as it is needed ‘as is’ for our charting and accounting system
Please feel free to redact your healthcare number on lab work before sending, or to fax the documents directly to our office.
Alternatively, if you prefer to fax your documents, please send us a note using the Contact Form on the FAQ & Contact page, and we will provide you with our fax number.
NOTE: If sending Intake and Service Option Forms for more than one person, please send them in separate emails, with the relevant attachments.
