INITIAL INTAKE FORMS
For all Saskatchewan patients please fill out the intake form prior to your visit and send it to Dr Rumancik. For all Vancouver patients you will be sent an online version of the intake form where you can either fill it out or fill this one out and bring it to your appointment.
if you do not know the answers to many of the questions do not worry; it is simply used to get the best idea of everything going on with you currently or that has gone on in the past.
if you do not know the answers to many of the questions do not worry; it is simply used to get the best idea of everything going on with you currently or that has gone on in the past.
Initial Intake (adult):
| adult_intake_form___consent.pdf |
Initial Intake (pediatric 0-13):
| adult_intake_form.pdf |
OTHER
Questionnaires & Trackers
The more information you can bring to your appointment the better! Thus, if you have extra time download and fill out the tracking forms to the best of your ability. This not only helps Dr. Rumancik develop your treatment plan more quickly it also brings insight to your health helping you bcome your own best Dr.
Daily Diet Tracker
|
Detox Questionnaire
|
Blood Sugar Tracker
| ||||||
Menstrual Cycle & BBT
|
Candida Questionnaire
|
Food Frequency Checklist
| ||||||
