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Patient Information Form

Please only complete this questionnaire in preparation for an appointment that we have scheduled for you. Completing this form does not add you to our waitlist or create a request to be seen. A referral from a General Practitioner is required to see one of our Physician Specialists.

RebalanceMD uses an online application to capture patient information. This allows our patients to complete necessary forms at home prior to appointments. Patients have more time to complete the forms, which improves the quality of information used during consults with our physicians.

The application is secure, and all collected information is confidential and only used during the treatment process.

Click here to complete your forms now. You will be asked to Register if it is your first time accessing the forms, or Sign In if you have previously created an account.

If you have questions or concerns please contact us