Brookfield Optimal Health
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Patient intake forms​

Please download and fill out one of the following patient intake forms. The form can be filled out in the PDF or printed and filled out on paper. Once you complete the form, please email it to [email protected]. If you have some initial questions or would prefer to have a free 10 minute consultation with NP Melissa Young prior to filling out the form, click here.

MEN

Click here to fill out Men's Intake Form
Click to set custom HTML
Patient Intake Form For Men.pdf
File Size: 49 kb
File Type: pdf
Download File

Women

click here to fill out women's intake form
Patient Intake Form For Women.pdf
File Size: 36 kb
File Type: pdf
Download File


Intake Process and Clinic Policies

Intake Process & Clinic Policies.pdf
File Size: 49 kb
File Type: pdf
Download File

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Men's Patient Intake Form
Women's Patient Intake Form
Contact us
Picture
1882 Niagara Stone Road, Virgil, ON
P: 905-468-2121
F: 905-468-2681​
Please ask for Catherine
HOURS
In Person: Thursdays
(By Appointment Only)

Telemedicine: Various Hours
(By Appointment Only)

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  • Home
  • About
  • BHRT / TRT
  • Men's Health
    • Case Studies
  • Women's Health
    • Case Studies
  • Resources
    • Patient Intake Forms
    • Educational Resources
    • Ideal Protein
  • FAQ's
  • Contact