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Intake Forms

As of July 2017, Dr. Tanya Wylde has decided to convert all of her patient files to a secure online electronic medical records (EMR) platform called JANE

When you speak with one of her receptionists they will ask for your name, date of birth, gender, telephone number and email so they can register you as a patient on the JANE EMR patient portal.  Our receptionist will send you a link via email to the new patient intake forms and consent forms found on the patient portal so you may fill them out.  Please ensure you give our receptionist the same email you plan on using to log into the patient portal.  By filling out your detailed new patient intake forms online, ahead of time, Dr. Tanya will have access to review your history ahead of time which will help her help you more efficiently.

There are various types of intake forms so please let our receptionist know if the appointment is for an adult or a child and if there is a specific concern such as a fertility issue or lactation issue so that our receptionist can send you the appropriate intake forms.

You may receive one of the following intake forms along with the four consent forms seen below:

Intake forms:

Adult Naturopathic Medicine Intake Questionnaire (–>Which includes a specialized Women’s and Men’s health section and Fertility section to be filled out where applicable)

Pediatric Naturopathic Medicine Intake Form

Lactation Consultation Intake Form

4 Consent forms:

1.Informed Consent to Naturopathic Diagnostic & Treatment Procedures

2. Privacy and Sharing of Information (Patient consent form for collection, use and disclosure of personal information)

3.Cancellation Policy, and no direct billing

4.CHR-Naturopathic Medicine Laboratory Testing

Patient portal

The patient portal allows you, the patient, access to fill out your new patient intake forms, access to your upcoming appointment dates and times, and your naturopathic treatment plans provided by Dr. Tanya at your visits.

 

 

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The Centre for Health and Rehabilitation 1160 Clarence St., L4H, 2V3, Unit 6, Vaughan, Ontario

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905-652-4811

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