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New patients can download a New Pediatric Patient History Form by using the button below.  


You need a password to open this form and fill it in. Please speak with Tricia in the office to get the password at 250 914 7832.

As per our privacy policy PDF passwords are only shared over the phone and are changed regularly. If you wish, you can email or fax the completed form back to Tricia before your child's appointment or bring it with you when you come to the office. If you choose to email the forms to they will be added to your records and the email containing them will be deleted.