Visit our Location
356 MacLaren Street, Ottawa
Give us a Call
613 230-0998
Send us a Message
info@dominickhussey.ca

Before your first visit with Dominick, we ask that you complete a health history intake form. Completing the forms will help us to ensure the best possible treatment for you.

You will need to complete two forms: The client agreement for Ottawa Holistic Wellness and the gender-specific Functional Medicine form.

Please note, if possible, you must complete and email your form at least two days before your consultation.

Ottawa Holistic Wellness
Client Agreement Form - English
Functional Medicine
Female Intake Form
Functional Medicine
Male Intake Form