Skip to content
| Call Us: (587) 480-0178
Sage Plus Logo Sage Plus Logo
  • Shop
    • Brain Health
    • Fundamental
    • Digestive Health
    • Immune Health
    • WellnessPlus™ Programs
  • Programs
    • WellnessPlus™ Programs
    • Workplace Wellness Programs
    • Supplement Consultations
  • Services
    • Flu Shots
    • Genomics (DNA Testing)
    • Weight Loss Programs
    • Consultations
    • New Service
      Online Consultations
    • Travel Health
    • Vaccinations
    • SLIT Therapy
  • About
    • Our Team
    • Holistic Practitioners
    • Pharmacy License
  • Contact
  • Book Consultation

Client Intake Form

Home>Client Intake Form
Client Intake Formsageplus2020-12-01T15:49:17+00:00
  • Date Format: DD slash MM slash YYYY
  • Section 1: Personal Information

  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • Section 2: Chronic Medical Conditions

  • i.e.: list of current prescription medication, lab work, food sensitivity, tests, etc.
    Drop files here or
  • Section 3: Nutrition Consultation

  • Physical Status

  • Diet

  • Section 4: Declaration of Consent

    Declaration and Consent of Resident or Resident’s Substitute Decision Maker (as applicable)
  • *
  • Date Format: DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.
Sage Plus Logo

Contact Us

Phone: (587) 480-0178
Email: [email protected]
Fax: (587) 480-0179
Address: 860 13 St S.E.
Calgary, Alberta T2G 1R2

Wellness Programs

  • WellnessPlus™ Programs
  • Online Health Consultations
  • Workplace Wellness Programs
  • Supplement Consultation

Health Services

  • Genomics
  • Weight Loss Programs
  • Travel Clinic
  • Public Vaccines
  • SLIT Therapy
Copyright 2020 Sage Plus Clinical Pharmacy | Privacy Policy | Return Policy

FLU SHOTS START ON OCTOBER 19th. BOOK YOUR APPOINTMENT NOW

Go to Top