Download and complete our new patient intake forms..

Patient Intake Forms

Our new patient intake forms can be downloaded below.  Please proceed as follows:

  1. Click the download button below the intake form heading you wish to download.  The form will download as a PDF document.
  2. The form that was downloaded can then be saved and then filled in electronically by clicking in the highlighted areas and typing.
  3. Once you have completed the form save it to your desktop. From here you have three options:
    1. Go to our APPOINTMENTS-General request page  or  APPOINTMENTS-Cancer request page,  complete the appropriate New Patient appointment request then click the SELECT FILE button. This will open a window that allows you to select your completed intake form from your desktop and attach it to your appointment request (drag & drop file is also available). Then SUBMIT and we will receive both the appointment request and the accompanying intake form. or
    2. Attach the completed form to an email using Outlook or other appropriate email software you may be using.  Send it to us at or, depending on whether it is non-cancer or cancer related.
    3. Print the completed form and 1) bring it with you to your scheduled appointment, or 2) Fax to 604-888-8365.

If you have any questions bout this process, please give us a call at 604.888.8325.

Please note that the Aesthetics intake form cannot not be filled in electronically at this time. It will need to be printed, completed and scanned to email to be sent.

Appointment Cancelation Policy

Please be advised that a minimum of 24 hours notice is required for appointment cancellations, otherwise you will be responsible for payment of a cancellation fee of 50% of the service fee. No-Shows will be billed at 100% of the service fee.

Cancer Intake Forms

Cancer - New Patient Intake Form


Referral Forms

Cancer - Patient Referral Form


IUD Referral Form


Breast Thermography Referral Form


General Health Intake Forms

Adult - New Patient Intake Form


Youth - New Patient Intake Form


Acupuncture - New Patient Intake Form


Aesthetics - New Patient Intake Form




Integrated Health Clinic
23242 Mavis Ave, Fort Langley, BC


Ph: 604.888.8325
Fx: 604.888.8365


Email from the Contact Us-Questions page.