Patient Forms

Patient Forms

Please have a medical history form completed for yourself or your child before you arrive.These forms are required at your first visit, and information submitted from these forms will be kept confidential and on file for future reference.


For Adults Medical History Form - For Adults

New Patients

Please complete a medical history form and bring it to your first appointment:

For AdultsFor Children

Burnaby Clinic Hours

  • Monday - Wednesday 9am - 5pm
  • Thursday  7:30am - 3:30pm

Terrace Clinic Hours

  • ONE WEEK PER MONTH
  • Monday - Wednesday 7:30am - 5pm
  • Thursday  8am - 4pm

Testimonials

"Dr. Jeannotte and his team are caring, professional and give back to their community." Clara N., Vancouver, BC