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    • Naturopathic Consults
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    • Intravenous Therapy
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JENNIFER RUMANCIK, ND
  • Home
  • About
  • Services
    • Naturopathic Consults
    • Private Testing
    • Ozone Therapy
    • Intravenous Therapy
    • Ultraviolet Blood Irradiation
    • Diet and Nutrition Consult
    • Women's Wellness Appointment
    • Fertility Support
    • Pregnancy Support
  • Resources
    • Articles
    • Recipes
    • Websites
    • Videos
    • Forms
  • Blog
  • Contact
  • Booking

 Forms

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. 

Initial Intake (adult):

adult_intake_form___consent.pdf
File Size: 243 kb
File Type: pdf
Download File

Initial Intake (pediatric 0-13):

adult_intake_form.pdf
File Size: 243 kb
File Type: pdf
Download File

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

diet_diary.pdf
File Size: 103 kb
File Type: pdf
Download File

Detox Questionnaire

detox_questionaire_01.pdf
File Size: 194 kb
File Type: pdf
Download File

Blood Sugar Tracker

blood_sugar_tracker.pdf
File Size: 77 kb
File Type: pdf
Download File

Menstrual Cycle & BBT

celsius_basal_body_temperature_chart.pdf
File Size: 94 kb
File Type: pdf
Download File

Candida Questionnaire

candida_questionaire.pdf
File Size: 27 kb
File Type: pdf
Download File

Food Frequency Checklist

food_frequency_checklist.pdf
File Size: 149 kb
File Type: pdf
Download File

  GET IN TOUCH

CONTACT INFO:​  ​info@drjenniferrumancik.com   PHONE:   306.331.0305 ​
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


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  • Home
  • About
  • Services
    • Naturopathic Consults
    • Private Testing
    • Ozone Therapy
    • Intravenous Therapy
    • Ultraviolet Blood Irradiation
    • Diet and Nutrition Consult
    • Women's Wellness Appointment
    • Fertility Support
    • Pregnancy Support
  • Resources
    • Articles
    • Recipes
    • Websites
    • Videos
    • Forms
  • Blog
  • Contact
  • Booking