• New Patient Intake Form v2.0

    New Patient Intake Form v2.0

    Please complete this form before you appointment with one of our doctors.
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  • History of Chronic or Viral Infections:

  • Social History

  • Is there anything in life that is causing you a lot of STRESS?

  • Relaxation and Meditative Practice e.g. mindfulness, yoga, Tai Chi, meditation

  • Please sign below to confirm that you acknowledge and accept the total Onboarding Fee which includes a pre-consult, first medical consult, and post-consult appointments. The fee is as discussed or advertised on the website. Also, by signing you are confirming that the above details are true and accurate. Please also note that Dr. Binjemain supports conventional cancer management or medical management and may also refer you to a suitable oncologist or specialist if you do not have one.

    CANCELLATION POLICY

    If you need to reschedule or cancel your appointment, please notify the clinic or cancel your appointment via the patient app at least two business days prior to the appointment. Cancellation messages left on weekends or after-hours will be treated as made on the next day the practice is open. A non-attendance fee of 100% of the consultation fee will be charged if you don’t attend or notify us in the required time frame.

    Reminder texts or calls are a courtesy to patients, and it is your responsibility to attend all appointments on time, else cancel or reschedule appointments in a timely manner. Where a patient cannot be contacted, confirmation is assumed, and a cancellation fee will apply.

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