Allergies & Sensitivities
1. I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above.
2. I understand that my personal and medical information is confidential and will not be disclosed to third parties without my written permission.
3. On a case-by-case basis, with written consent, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as necessary for my beneficial treatment.1.
I understand my appointment time is reserved just for me. A late cancellation or missed visit leaves a schedule gap that could have been filled by another patient. As such, I agree to provide at least 24 hours notice for any cancellations or changes to my appointment. If I provide less than 24 hours notice, or miss my appointment ('no-show'), I will be charged for the full cost of the missed appointment.
Initial - $190, Regular Follow Up (15-30 mins) - $95, Extended Follow Up (30-45 mins) - $142.50
Additional treatments and testing are variable in cost and will be discussed with you.