Profile Information — Step 1 of 3

You are completing the following intake forms: Lakeside Wellness Intake Form

New Clients: Please take a moment to fill out our online intake form. Intake forms can also be found in our lobby. Please ensure you arrive approximately 10 minutes before the time of your appointment if you choose to fill out your intake form upon arrival.

* First Name

* Last Name

* Email

* Mobile Phone

Please provide at least one phone number. Your mobile number can be used to look up your account and receive text message appointment reminders.

Home Phone

Country

Street Address

City

State

Postal / Zip

* Date of Birth

* Gender

Occupation

How did you hear about us?

Questionnaires — Step 2 of 3

You are completing the following intake forms: Lakeside Wellness Intake Form

Consents — Step 3 of 3

You are completing the following intake forms: Lakeside Wellness Intake Form

Email Communication

Transactional Emails

You can opt to receive emails to keep you informed of new bookings, changes to your bookings, and reminders for upcoming appointments.

I would like email notifications of new, cancelled, and rescheduled appointments

Lakeside Wellness Intake Form — Consents

Accuracy of Information

* I certify that the above medical information is correct to my knowledge.

Privacy and Sharing of Information

I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission. My permission will automatically be granted when I schedule an appointment with another practitioner at Lakeside Wellness.

* I have read and understand the Privacy and Sharing of Information Policy.

Cancellation Policy

While we understand that emergencies may arise, we kindly request that cancellations are made as far in advance as possible and only when absolutely necessary. Our practitioners reserve space for you each day and are only paid when services are provided.

Appointments cancelled in less than 48 hours to the time of their appointment and no-call, no-show situations are subject to a minimum of a $20 cancellation fee with the maximum being the total cost of the appointment or loss of gift certificate, special offer or previously purchased voucher.

If more than three appointments are cancelled in less than the required 48-hour cancellation notice you will be required to pay in advance via credit card for any future services. No refunds or credits will be offered if you cancel less than 48 hours before the time of your appointment.

Late arrivals will have that time deducted from their appointment.

* I have read and understand the Cancellation Policy.

Sexual Misconduct and Inappropriate Behavior Policy

Any illicit, sexually suggestive remark or advance, physical advance, inappropriate or lewd behavior or the like will result in immediate termination of your session. Full payment will be required regardless of the duration of your shortened session. Any sessions terminated due to this behavior will also result in being permanently banned from scheduling with any practitioner at Lakeside Wellness.

* I have read and understand the Sexual Misconduct or Inappropriate Behavior Policy.

Packages, Specials and Promotions

Each practitioner at Lakeside Wellness is an independent contractor and establishes their prices accordingly, so prices, packages, specials and promotions will vary from one practitioner to the next.

Packages, specials and promotions are specific to the practitioner you are purchasing from and are non-transferable unless otherwise specified.

Lakeside Wellness is not responsible for any financial losses incurred from the purchase of packages, specials or promotions.

Terms and conditions on all packages, promotions and specials are strictly enforced.

* I have read and understand the Packages, Specials and Promotions policy.

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