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We are pleased to offer the downloadable and printable forms in PDF format below below that you can fill in and bring with you to your first visit to our office.

You can click on any of the links below to open a PDF form in a new browser window. Alternatively, you can right-click on any of the form links and choose "Save target as" to save the file to your own computer.


New Patient Intake Form
New Patient Intake - Pediatric / Child Form



New Patient Intake Form - Adult
New Patient Intake Form - Minor / Child
New Patient Intake Form - Holly MacGougan

Lendrum Health Centre

5846 - 111 Street NW
Edmonton, AB

See map of clinic location

Phone: 780-433-1499

Fax: 780-433-1890


Monday and Wednesday 12-6 pm
Tuesday and Thursday 8-5 pm
Friday 9-3 pm
Closed Sat & Sun

Lendrum Health Centre

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