ND General Intake Form
ND Patient Informed Consent and Acknowledgement
Chelation Therapy Consent
Intravenous Therapy Consent
Polo Pediatric Intake Form
Colon Hyrdotherapy Consent Form
Colon Hyrdotherapy Intake Form
Counsellor Intake and Consent Form
Dietitian Intake Form
Dietitian Consent Form
Holistic Nutrionist Intake Form
Intake and Consent
Office Policies
General Intake Form
Botox Consent
Fillers Consent Form
General Intake Form
Bio-Identical Hormone Consent Form
Privacy of Information and General Clinic Policy
Polo Health + Longevity Centre
711 Columbia Street
New Westminster, BC V3M 1B1
Located in the Heart of New Westminster, BC
and proudly serving Vancouver and the
entire lower mainland,
T: 604-544-7656
F: 604-544-7657
E: info@polohealth.com
Your appointment time is reserved just for you. A late CANCELLATION or NO-SHOW leaves an unfilled gap in the practitioner's schedule that could have been filled by another patient in need. As such, we require 24 hours notice for any CANCELLATION or changes to your appointment. Patients who provide less than 24 hours notice, or NO SHOW their appointment, will be charged a CANCELLATION OR NO SHOW fee of $100 to the card on file. We understand that emergencies happen, but we kindly ask for as much notice as possible so we can continue to provide consistent care to all patients.
No other appointment will be booked until this fee is paid.
Appointments are subject to change as per practitioner’s schedule