Dr. Katrina Traikov ND

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Patient Intake Forms and Consent Forms

Select the best intake form to meet your needs.

Select the version for Pembroke if you plan on having your first visit at our Pembroke location, and Renfrew if you plan on having your first visit at our Renfrew location.

Generally, the long adult intake forms are preferred, as they give us a more comprehensive look at your case.

The short adult intake forms are available if a shorter form is needed.

The child intake forms are generally for children 12 and under.

Note: Please read the included consent forms. If there is anything you do not agree with, please strike it out and initial it. The email consent is completely optional. Many patients do not wish to communicate by email as it is not a secure means of communication.

Long Adult Intake and Consent Forms

Long Adult Intake and Consent Forms – Pembroke

Long Adult Intake and Consent Forms – Renfrew

Short Adult Intake and Consent Forms

Short Adult Intake and Consent Forms – Pembroke

Short Adult Intake and Consent Forms – Renfrew

Child Intake and Consent Forms

Child Intake and Consent Forms – Pembroke

Child Intake and Consent Forms – Renfrew

If you have any questions feel free to e-mail us at info@valleynaturopath.ca or call the clinic in Pembroke or Renfrew (see below).

  • Contact and Payments

    Contact

    To book an appointment call Active Chiropractic
    at 613-732-9215 or Renfrew Chiropractic at 613-431-7272

    To contact Valley Naturopath call 613-631-0137 or
    Email info@valleynaturopath.ca

    Accepted Payment Methods

    Accepting VISA, Master Card, and Interac

    Naturopathic medicine is covered by most extended health plans (check with your insurance provider for details), or can be claimed as a medical expense on your tax return.

  • Locations

    Locations

    1169 Pembroke Street East
    Pembroke, Ontario,
    (out of Active Chiropractic)

    1035 O'Brien Road #23
    Renfrew, Ontario,
    (out of Renfrew Chiropractic)

    Hours

    Mondays 10 am - 4 pm
    Tuesdays 10 am - 7 pm
    Wednesdays 10 am - 7 pm


    Thursdays 12 pm - 7 pm

    Home and phone visits available by request.
    Click here to contact us for more information.

    Valley Naturopath is the Ottawa Valley’s choice for personalized alternative, integrative and holistic health solutions. Serving Pembroke, Petawawa, Deep River, Renfrew, Cobden, Eganville, Killaloe, Barry's Bay and Renfrew County.

  • Request Katrina as a Guest Speaker

    Request Katrina as a guest speaker

    Katrina enjoys speaking on a variety of health topics. Her talks are fun and engaging. From stress management and relaxation, to eating for heart health, to healthy aging, an ounce of prevention is worth a pound of cure! Click here to request Katrina as a guest speaker at your next community group, support group, or office meeting today!

  • Disclaimer

    Disclaimer

    Any information presented here is provided for educational purposes only and is general in nature. It is not intended to be health advice for any individual. Please speak to your health provider before making any changes – dietary, lifestyle or otherwise - for direct and individualized advice. As information changes constantly, the accuracy and completeness of any information presented here cannot be guaranteed. Access of the information presented is solely at your own risk. It will be assumed that access indemnifies Valley Naturopath and any person involved in the preparation of the information presented here from any and all injury or damage arising from such use.