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Welcome to Revivelife™ clinic.  For your appointment you will be requested to fill in intake forms.    You can fill them out online, or call the clinic at (613) 829-7100 to have the forms faxed or emailed to you.

General Information

  • Your First Visit FAQs
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General New Patient Visit Forms

  1. Intake Form -Adult  OR Intake Form -Child
  2. Ienergy Health Advisor Questionnaire
  3. Health Consent Form
  4. Credit Card Authorization Form
  5. Hormone Welcome & FAQs Form (Hormone Clients Only)

Chiropractic Forms

  1. Chiropractic Health Consent Form

We encourage new patients to bring all relevant laboratory reports to their first visit.

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Revivelife Clinic  |  2249 Carling Ave. Suite 320 Ottawa ON K2B 7E9  |  Phone: 613.829.7100  |  Fax: 613.829.2608