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New Patients Intake

PLEASE REFRAIN FROM USING ANY SCENTED PRODUCTS WHEN VISITING THE CLINIC: PERFUMES, SHAMPOOS, AFTER SHAVES, CREAMS, LOTIONS, DEODORANTS, SOAPS and LAUNDRY DETERGENTS. Many of our patients suffer from severe environmental allergies and this is for their protection.PLEASE REFRAIN FROM USING ANY SCENTED PRODUCTS WHEN VISITING THE CLINIC: PERFUMES, SHAMPOOS, AFTER SHAVES, CREAMS, LOTIONS, DEODORANTS, SOAPS and LAUNDRY DETERGENTS.

Please DO NOT BRING ANY PETS into the clinic. Many of our patients suffer from severe environmental allergies and this is for their protection.

Please let us know if a WHEELCHAIR ACCESS is necessary, so we arrange any help needed to enter the building.

New Patient forms and information

Instructions for printing the forms: please print each form separately, for example, Form 1 and Form 2 not on the same sheet of paper. If a form is a few pages long, it can be printed on the both sides of the paper.

Fill the forms out and bring them to your first visit. Do not hesitate to contact us if you have any questions.

IMPORTANT: Read our POLICY.

Please select the forms you need to fill out from the list below:

 

Note: It may take a few minutes to open the forms due to a large file size.

Please, complete all forms and questionnaires prior to arriving for the initial visit.

These preparations should be followed for the first visit:

  • No alcohol consumption for 24 hours
  • 2-4 glasses of water within 2 hours of visit
  • No exercise, caffeine or food for 4 hours prior to arrival

INITIAL VISIT. During this time the following will occur:

1) Weight, height and blood pressure readings are taken.

2) Blood will be taken for various blood tests such as Oxidative Stress Analysis and Antioxidant. Urine and stool samples are taken. Hair analysis and other specialty tests will be performed. This includes Body Composition (BIA) and Cardiovision. Ph testing tape with the instructions will be given to measure ph balance at home.

3) Completing any forms that have not been finished and obtaining various consents.

4) Full medical history and physical examination taken.

5) Discussion of any health problems and an initial treatment program will be composed. This program might include supplements and intravenous treatments. Additional tests may be prescribed at that time.

Payment for Service

A portion of the visit is covered by OHIP. A separate cost applies when complementary topics are discussed.

Please make sure that both your OHIP number and mailing address are correct. 

The method of payment is cheque, cash or debit. If payment is by cheque, it is payable to Preventimed.

PAYMENT IS DUE AT THE TIME OF THE VISIT. Prices are subject to change without notice.

New Patient fee structure age 16+

Costs for children are determined by length of office visit and testing necessary.

Tests and appointments that are NOT COVERED BY OHIP:

Hair Analysis $115
Bioelectrical Impedance Analysis $25
Oxidative Stress Analysis $105
Antioxidant $90
Cardiovision $35
Electro-Dermal Screening $120
Ph Balance Testing $20
Nutritionist’s Consultation $100
Environmental Awareness Class $75

 

The following costs are COVERED BY OHIP:

Annual Health Exam $77.20
General Assessment $77.20
Intermediate Assessment $38.15
Minor Assessment $21.70
Counseling ½ hour or major part of administrative services $62.75
Clinic ProceduresVenepuncture  
Adult $3.54
Child (ages 2-15) $7.35
Infant (under 2 years) $9.90

 

Appointments Reminders

Two business days before your visit, the receptionist will phone with a reminder for booked appointment. Please reply to her message.

The patient/client is ALWAYS responsible to call 48 hours prior to the scheduled appointment time to reschedule or cancel.

Late cancellation charges and Missed Appointments (no show)

If you are not able to make your appointment as scheduled, your doctor or practitioner needs to know in advance so that other patients who are
waiting for an appointment can be contacted.

If a late cancellation/rescheduling made within the 48-hour period (less than two business days notice is given) the following charges are applied:

  • $150 for a new patient/client visit
  • $75 for a follow-up visit

If you missed an appointment (didn’t show up) without any notice, the full appointment fee will be charged to you. It will depend on who an appointment was with as our practitioners and doctors have different fees.

Other Important Information

You should know that the Centre is very busy and it could be some wait time at the office.

Our practitioners review all laboratory tests results on a regular basis. You will be contacted only if your lab test results are of an urgent nature.

Related pages

The Policy of the Jaconello Wellness Centre for Integrative and Anti-Aging Medicine

Payment for service

Refund Policies