Prospect Information Intake Form – Complimentary Consultation

Please fill out this preliminary intake form in order to schedule a 10-minute phone call with Dr. Kait Chang, ND. This call is important for you and Dr. Chang to determine whether she is the right healthcare provider for you. All information you provide will be confidentially protected under the Personal Information Protection Act and Health Information Act.

Do you currently have a team of healthcare professionals? Please check the following:

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