
The first step in booking an appointment is completing the Intake and Service Option Form, which provides me with basic information about you and the nutrition support you are seeking, so I can prepare for your appointment.
To start specialized services for a 2:1 therapeutic ketogenic diet, a 3:1 therapeutic ketogenic diet, or hEDS, EDS, or POTS, please visit those pages and follow the “Get Started” steps outlined there.
Getting Started is as easy as 1-2-3
You only need to complete 3 pages: the first two and the last. The other pages list available services for you to tick off the one(s) you want.
- All boxes on the form must be completed, as we need this information to understand your needs to set up an appointment. For this reason, we will return incomplete forms.
- Please do not exceed the capacity of boxes on the form, as this makes the form unreadable on our end. If needed, you can complete the “Additional Health Information Form” (link below).
- Please avoid using ALL CAPS when completing forms.
Short on time now? Both options below provide a link so you can email the form to yourself and complete it later.
We are both HIPAA-compliant (healthcare data) and PIPEDA-compliant to meet Canadian privacy requirements under the Personal Information Protection and Electronic Documents (PIPEDA) Act.
Complete the Intake and Service Option Form
Need more room to type than the boxes hold? Read here:
NOTE: Please do not exceed the capacity of boxes on the form, as it becomes unreadable from our end. If you need more room to list diagnoses, medications, or medical details, (1) please write “see Additional Health Information Form” in the box that is too small on the Intake and Service Option Form, finish completing the form, then click “Submit”. Then (2) complete the “Additional Health Information Form” by clicking here, then click “Submit”.
OPTION B: Book via Email or Fax
Download and Complete the Intake and Service Option Form Manually
Click Here to Download Form & Step-by-Step Instructions
1. Download the Form
Download the Intake and Service Option Form (dated June 1, 2026) to your computer.
NOTE: All boxes on the form need to be completed because we need this information to understand your needs and set up an appointment. For this reason, incomplete forms will be returned.
Please avoid using ALL CAPS when completing this form.
✉️ On your phone? Email this PDF link to yourself to open later on your computer
If you want a password-protected form, please send us a note through the Contact Us form, and we will send one.
2. Complete the Form
Complete all the boxes on the form on your computer, tablet, or smartphone. For a Windows device, use the free Adobe Online tool, or for a Mac device, use Preview.
Need help? Step-by-Step Instructions here.
NOTE: Please do not exceed the box capacity on the form, as it becomes unreadable. For boxes that need more space, download the “Additional Health Information Form” to your computer, complete the fields that need more space, and send it with your other documents.
3. Email or Fax Your Documents
Email your completed Intake and Service Option Form to the address on the first page of the form, or request our fax number.
- 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.
NOTE: If sending Intake and Service Option Forms for more than one person, please send them in separate emails, with the relevant attachments.
Note: If you are a Healthcare Provider looking to refer a patient or a Rehabilitation Consultant, please visit the FAQ page.
