Intake and Consent

Prior to visiting Bellevue for the first time we would like you to provide us with an overview of your medical history. All of the information you provide is confidential. Please download and print the applicable forms below.

After reading, and filling out the forms, please fax them back to our office at (604) 913-2261, email them to, or drop them off at our office at 1467 Bellevue Avenue, West Vancouver, BC  V7T 1C3. Of course, you can always bring them to your first visit!

Bellevue Natural Health Clinic is pleased to offer the following services: Naturopathic Medicine, Acupuncture, Chinese Medicine, Massage Therapy, Counselling, Holistic Nutrition, Infrared Sauna, Klean Kanteens, and more!

Naturopathic Medicine Adult Intake Form

Naturopathic Medicine Pediatric Intake Form

ND Informed Consent Form

TCM & Acupuncture Intake Form

Massage Intake

Diet Diary for Nutrition

Bellevue Natural Health Clinic Policies

Cancelations: We require 24 hours notice in order to cancel or re-schedule your appointment. Failure to do so may result in a late cancelation charge.

Extended Health Insurance: Many of our services are covered by extended health insurance. All visits must be paid in full at time of service. The clinic will provide a detailed receipt with your practitioner’s name and registration number for insurance purposes. Receipts are provided either at the time of service, or as an extended statement at the end of the year. Additional copies are available for 25c per page.

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