Forms

Please click on the links below to download pdf files of the Complete Intake Questionnaire for Adults and Children or the Small Animal Intake Questionnaire for veterinary patients.

◊ Complete Intake Questionnaire for Adults and Children

◊ Complete Small Animal Intake Questionnaire (veterinary)

Regarding Vaccines and Vaccinations:

Homeopathy has studied the use of vaccines as medicines and has kept much clinical and proving data on their extensive effects in the body. Conventional medicine is also aware of these symptoms and effects (consult The Physician’s Desk Reference for a partial listing of known side effects). Much of our work involves trying to correct the damaging effects of vaccines on human health; and we know that certain individuals are far more susceptible to vaccine damage than most (while some may actually benefit from vaccines). It is my job as a physician to make you aware of those susceptibilities if they apply in your case, so that you may limit your risk of harm.

Ultimately, the decision to vaccinate or not to vaccinate is a personal one. I do not make the decision for you, or promote one side over another. I simply point you in the direction of resources and encourage you to educate yourself on all the risks and benefits involved, all your options in terms of consent, and all your avenues for recourse should there be any difficulties resulting from exposure. I do not advocate avoiding vaccines unless you are ready to use effective methods of alternative protection from epidemic and endemic diseases as your primary medical care system.

Where animals are concerned, I encourage you to consider the vaccination requirement for the Rabies vaccine seriously. If you wish to avoid exposing your pet to repeat vaccinations for Rabies, there are Titre tests available which will help you determine whether or not your pet still has immunity from the disease after the initial vaccine is given. Many pet owners are eager to keep their pets vaccination free, but the law regarding this issue is very clear: you will be forced to put your pet down for an autopsy should your pet be reported to the authorities for biting another human being. Accidental bites are common despite the fact that most pet owners are conscientious about training and restraining their pets, but any “bite” complaint to authorities will put your animal at risk. 

Below you will find links to current schedules for infant, child, and adult vaccinations in Canada. These are provided to help you fill out my intake questionnaire forms.

I’ve also included links to sites for vaccine exemption laws and forms, and links to information about pets and vaccines. If the vaccinate/don’t vaccinate decision is one you need to make, I can provide you with extensive reference materials to help you learn about and consider all sides of the debate and research so that your decision will be fully informed.

For reference only:

Schedules for Infants and Children, and schedules for Adults

Please click on these links for information on how to acquire and properly fill out the Canadian Provincial Vaccine Exemption forms:

Forms

Further information and resources

Pet vaccine schedules and information