We are humbled by the support shown by our community during this unique time – thank you, thank you, thank you! We’re are overjoyed to be back at it and we’re slowly reopening, department by department.

Chiropractic appointments available in office starting May 11. Physiotherapy appointments available in office starting May 19. Dr. Nakama is seeing patients in office for consultations, prolotherapy and IV therapy May 25. Skincare supplies can be ordered by emailing shareenm@six08health.com

And for the most up to date information about our plan to reopen, please follow us on instagram and facebook.

Stay safe – East Meets West & SIX08 Health Team.

New Patient Form

new patient Form

The information requested below will assist in the practitioner treating you safely. Feel free to ask any questions about the information being requested. Please note that all information provided below will be kept confidentially unless allowed or required by law; your written permission will be requested to release any information.

Date:
Date:
Personal History

1. Title:

2. Name: *
2. Name:
3. Date of birth:
3. Date of birth:
4. Address:
4. Address:
5. Home phone:
5. Home phone:
6. Cell phone:
6. Cell phone:




12. How did you hear about this clinic?


13. Emergency contact:
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14. Emergency contact’s phone number:
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16. Do you have insurance? *
If you answer yes, please tell us the name of insurance company


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17. East Meets West Health Centre would like your permission to contact you by email for appointment reminders, promotional offers, etc.
You will be able to unsubscribe at any time