ELITE SPORT PERFORMANCE
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Chiropractic Intake From

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33%
  • Date Format: YYYY slash MM slash DD
  • Personal Information

  • Date Format: YYYY slash MM slash DD
  • Family Doctor (GP)

  • Emergency Contact

  • Other Information

    Please be advised that we do not accept WCB cases.
    If yes, additional intake forms are required.
  • Our clinic is committed to evidence-based practice and contributing to the scientific research community. All patient information used in research is kept strictly confidential and is used only with permission of the patient. Do you consent to allow your information to be used in future research?
  • Missed office Visits:
    A charge of $80 will be made in the event of a missed office visit, or if less than 24 hours’ notice is given when canceling an appointment.

    Re-examinations:
    Re-examinations are done in the event of a six month time lapse between office visits

  • Health Information

  • 0 is no pain, 10 is severe pain
  • Physical History

  • Please mark a 1 beside any conditions you have had in the past
    Please mark a 2 beside any condition that you have presently
  • Musculoskeletal system

  • Nervous system

  • Cardio-Vascular-Resp.

  • Genito-Urinary system

  • Gastrointestinal system

  • Ear, Eyes, Nose, Throat

  • Female

  • Your first visit to the office includes both an initial consultation as well as an office visit. At the discretion of the doctor, your first visit may not consist of actual treatment.

    Attire/Hygiene

    Some treatments necessitate direct skin contact. Please bring shorts to each appointment and bathe before attending your appointment.

    Please refrain from wearing any cologne, perfumes or scented lotions while in the clinic.

Contact Us

Call Us:
Knee Clinic: 403-457-5633
Elite Sport Performance: 403-689-9889

Visit Us at:
535 – 10333 Southport Rd. S.W.
Calgary, AB T2W 3X6

Click Here to Email Us

Knee Brace Support or Returns

Clinic Hours

Monday – Thursday 7am to 7pm

Friday – 7am to 5pm

Saturday – 10am to 2pm

Closed Sundays

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