If you are a new patient to our clinic, welcome!

While we understand that filling out forms is never fun, we ask that you please make sure to be as accurate and detailed as you can. The information you provide will give the practitioner treating you a clear picture of your medical history, and will allow them to make a more complete assessment.

If you have any questions, or need help filling out any of the below forms, please feel free to call our office at 604-732-3422. One of our staff will be happy to assist you.

New Patient Forms

Patient Info

Informed Chiropractic Consent

Fees and Policies

If this is your first visit to our clinic, or first treatment with Dr. Larsen, please fill out the above forms.

If you are unable to complete the New Patient forms prior to your arrival at our office, we ask that you arrive 15 minutes before your scheduled appointment time.

Please note that treatment cannot take place until you have completed and signed the above forms.

Benefit Assignment Form and Authorization

Benefit Assignment Form and Authorization

If you have coverage with any of the providers listed below, please fill out the above form and let staff know at the beginning of your appointment.

Pacific BlueCross, Canada Life (Great West Life), Manulife Financial, SunLife Financial, Claims Secure, Desjardins Insurance, Industrial Alliance, Johnson Inc, Johnston Group, Cowan, Manion, Chambers of Commerce Group Insurance Plan, Group Health, Group Source, First Canadian, and Maximum Benefit

Update Forms

Update

Informed Chiropractic Consent

If you have previously been treated by Dr. Larsen, but have but have experienced a break in treatment for a period of 6 months or more, please fill out the above forms.

If you are unable to complete the Update forms prior to your arrival at our office, we ask that you arrive 5 minutes before your scheduled appointment time.

Please note that treatment cannot take place until you have completed and signed the above forms.

ICBC Questionnaire

ICBC Questionnaire

If you have recently been in a motor vehicle accident, or have an ongoing ICBC claim, please fill out the above Questionnaire.

The last three pages of the intake form are required surveys by ICBC. Please ensure that you are as accurate as possible and complete all boxes that apply. Keep in mind that the Neck Disability Index only applies to neck pain (only complete it if you have neck pain), and the Back Pain Disability Index only applies to back pain (only complete it if you have back pain).

WCB Questionnaire

WCB Questionnaire

If you have recently been in a work place accident, or have an ongoing WorkSafe claim, please fill out the above Questionnaire.