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 me develop your treatment plan more quickly it also brings insight to your health helping you heal as fast as possible.
Daily Diet Tracker
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Detox Questionnaire
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Blood Sugar Tracker
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Menstrual Cycle & BBT
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Candida Questionnaire
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Food Frequency Checklist
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GET IN TOUCH
CONTACT INFO: info@drjenniferrumancik.com PHONE: 306.331.0305
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VANCOUVER OFFICE:
Accel Health & Athletics 565-1090 W Georgia St Vancouver, BC V6E 3V7 Front Desk: 604.428.4593 BOOK ONLINE |
ABBOTSFORD OFFICE:
Abbotsford Midwifery & Wellness 2001 McCallum Rd #206 Abbotsford, BC V2S 3N5 Front Desk: 604.859.4430 BOOK ONLINE |
ALSO MAKING PERIODIC VISITS TO SK:
Krause Care Pharmacy 310 W Broadway St Fort Qu'Appelle, SK S0G1S0 TO BOOK CALL: 306.331.0305 |
