Get Started

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
• Insurance Info
• Fees

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.

• Get Started

  • Referrals
  • Your First Visit FAQs
  • New Patient Intake Form – Adult
  • New Patient Intake Form – Child
  • Ienergy Questionnaire (IEQ)
  • Insurance Info
  • Consent Forms
  • Pricing