Patient Forms

Patient Forms for Various Packages

New Patient Information

Dear New Client,

Congratulations on taking this important step in making your health a priority and committing to Naturopathic Medicine as a part of your health care plan. Naturopathic Medicine is an inclusive healing system that can help you achieve your health and wellness goals. The Benefits of optimal health will be proportional to the effort and dedication you put into your daily choices. You have the option to feel better, live healthier, longer, look and feel younger. It is found that lasting improvement in one’s health takes place in the presence of heightened focus, dedication and education.

Naturopathic Doctors are trained as primary health care providers. We use similar physical exams and laboratory tests and recognize the same signs and symptoms as medical doctors do. The main difference between a Naturopathic Doctor and your conventional family doctor is the philosophy of care and the treatment options that are available to you. Naturopathic Doctors strive to identify and reverse the underlying causes of your health concerns using gentle, safe therapies that restore your natural ability to heal and support your journey toward lifelong optimal health. We are committed to maintaining the highest professional ethics, competence and personal integrity.

Naturopathic Health and Wellness Centre

Your careful consideration of each of the enclosed questionnaires will enhance our efficiency, improve our accuracy and will provide more effective use of your scheduled consultation time.

Please read and complete each form to the best of your ability. Note, you will have to get started on the diet survey promptly as this requires time and careful attention. Many find that completion of these forms a valuable process in itself. If you feel that we have overlooked anything pertaining to your health, please add it to the package.

Important: please bring any supplements & medications you are currently taking with you to your appointment. Also, please bring with you any lab work (blood, imaging reports etc.) that may be relevant.

Thank you for your time. We look forward to helping you achieve your health goals.

What to do when you arrive?

When you arrive at the clinic please check in with the main Reception desk as you enter the clinic. Our Naturopathic Receptionist will come greet you and give you an office tour. She will then bring you to the Naturopathic reception area in preparation to your appointment.

At subsequent appointments please make your way to the Naturopathic Reception to check-in. Your Naturopathic Doctor will be with you shortly.

It is always our aim to be on time with your appointments. However, complications and emergencies do arise and in these circumstances we appreciate your patience and understanding. You also will receive the devoted time and care of your Naturopathic Doctor.

If you need further clarification or assistance, please feel free to call us at (519) 273-0777 for assistance.

Dawn Cormier, HBSc, ND, Qigong Practitioner.

Fee Schedule

Naturopathic services are not currently subsidized by OHIP, however many private health plans cover all or a portion of naturopathic treatments. Patients are encouraged to request that their private policy include coverage of all naturopathic services. Please contact us for detailed questions regarding fee schedule information. Naturopathic services are now HST exempt effective Feb. 12, 2014. HST is still applicable to Naturopathic supplements and some laboratory services.


Please note:

These prices to the service fees are affected as of January 1, 2024

Naturopathic Care
Initial Consultation -90 minutes $292
Extended Naturopathic Consultation – 60 minutes $170
Naturopathic Consultation – 45 minutes $154
Naturopathic Review – 30 minutes $115
InLight Therapy $85
Acupuncture – 30 to 60 minutes $80 - $115
Quantum Energy Healing session/Emotion Code/Reiki - 90 to 120 minutes $175
Meridian/Chakra Balancing/Qi~ssage/Qigong/Crystal Bowl Sound Therapy - 60 minutes $155
CranioSacral Therapy $145
Darkfield Lab Analysis – 60 minutes $170
Ear Wax Removal $35
Other Services
Phone or E-mail Consults (per 15 min.) $40
Forms or Comprehensive reports $16-128
Additional Lab Services Available

Prices vary according to Service. Note that there is a lab processing fee of $25 where applicable.

Please refer to Laboratory Services tab for a list of services provided.

Please note that payment is due when services are rendered. We accept VISA, Master Card, Cheques, Debit and e-Transfers for payments. Fees are subject to change.


Head Start Package

Healing is an inside job – mentally, spiritually and physically. I can’t do this work for you at home, this is something you have to embrace. I invite you to think of your current health situation as a ‘call to action’, a ‘reboot’ as it were, an opportunity to honour your body and attend to its needs. Every one of us has the power to take back our health and ignite our own wellness revolution in our life. No one can take better care of you than wise, brilliant, capable and STRONG you.

You will find this a journey that grows you and offers many gifts along the way. So congratulations on taking this trip towards wellness. I ask that you keep an open mind and have fun with it. Get creative.

Naturopathic Health and Wellness Centre

I’ve put together this wellness practice information package to get you started. It takes a general approach to healthy changes that will jump start you towards your goals. Naturopathic visits in the office can often get technical as I work towards assembling the physiological needs of your body, discovering your major stressors and primary issues and sometimes I don’t have time to touch on these basics. This handout covers some crucial areas of your life that you can begin focusing change on (if you haven’t already). Note, they are general in nature, your specific needs will be revealed as we progress through care together.

Let’s just hack an all too often limiting belief about health up front. It goes like this: “I don’t have enough time or $ to be healthy”. Truth is we all have the same amount of hours in a day, letting this excuse stand in your way, may one year from now have you exactly in the same place you are now.

I encourage you to reflect on how you choose to spend your time and money and what you put your attention on. Trust me, you have time to incorporate healthy practices into your day, you don’t have enough time to get sick – being sick is a full-time job you don’t want.

I suggest you to print this out, read it and keep it handy for reference.

If you have questions, please bring them to our visits and we can explore them. Let’s have fun together, life is for joy not suffering.

I would also encourage you avoid thinking or say the famous phrase “I will try” when approaching any health practice. It is a set-up for failure. May I suggest you take the approach of “I will endeavour to work on this and take care of myself”. Be curious and have fun. Don’t worry there is no test here, no judgement, just support and encouragement.

Health is a journey of discovery and enlightenment, one step at a time.


There is no magic wand I can wave to protect you from the ravages of chronic sleep deprivation. Sleep is the most efficient & important way to establish well-being, heal, repair, restore and regenerate your body and mind. It’s imperative that you learn to master your sleep. Sleep is a goal in itself!


Naturopathic Health and Wellness Centre

Don’t fall for these Urban Myths:

“Busy, productive people need less sleep”

“You snooze you lose”

“Sleep is for lazy people”

Many people hack their life-force energy trying to survive on 6 hours or less sleep a night. This simply is not enough unless you’ve mastered the art of meditation at an advanced level.

Sleep debt effects every aspect of your life, especially your moods and how you show up in the world. It can tear down your personal relationships and destroy your work performance. Over time, it will de-rail your health.

Some serious side-effects of poor sleep are

Sleeping is paramount to good health but what most people don’t realize that it also allows you access to your non-local mind (spiritual consciousness) which is very important for your spiritual growth and creativity. You lead a more conscious life if your sleep is deep and allows all phases to occur, rather than a reactive frazzled life that runs on very little sleep.

Sleep is also the time when your body detoxifies, heals, rebuilds and restores you. Your healing crew comes out to fix your bod when you sleep.

Sleep Rules
  • 1 Caffeine has a half-life of 6-8 hours, so stop consuming caffeine beverages early enough in the day so you fully metabolize it and it doesn’t impact your sleep negatively. I recommend stopping caffeine by 2 PM.
  • 2 Alcohol, most people think it helps them get to sleep (stage 3 & 4), which might be true, but it hinders deeper phases of sleep. So if you are drinking alcohol, you must give yourself time to absorb the alcohol before you sleep. The rule is one hour for each alcoholic drink. So if you drink 3 glasses of wine, give your body 3 hours before you go to sleep.
  • 3 Avoid blue light exposure before bed (phones, iPads, computers) because it is like caffeine for your brain. The blue light hinders your pineal gland from producing melatonin which is critical for sleep. Tuck away your tablet/iPhone/computer/phone, whatever it is that distracts you from preparing and getting to sleep. Put away your to-do list for another day and get ready for restoration time. We live in a technology age with conveniences and artificial lighting that keep us out of touch with our natural sleep/wake cycles we were meant to follow. So avoid the use of these devices 2 hours before bed or use blue light glasses to block that light.
  • 4 Exercise is a simple way to improve your length and depth of sleep. As little as 20-25 minutes a day can help your sleep. However, if you do it too close to bed time it may affect your ability to fall asleep. It is suggested not to exercise 4 hours before going to sleep.
  • 5 Establish a good circadian rhythm, and a good way to do this is go to bed and wake at the same times every day and upon waking get sunlight exposure within 30 minutes (go outside) and sleep in total darkness (block streetlights with blackout curtains, no LED clocks, hall lights, night lights etc.).
  • 6 If you wake frequently in the night it may be because your brain has run out of fuel. REM and deep sleep require a lot of fuel. So eat before bed and see if this improves
  • 7 Improving napping can benefit you, but it depends on what type of napping. The best nap time for most people is 25 minutes or less or a full sleep cycle for 90 minutes if you’ve missed a lot of sleep the night before. The optimal time of day to nap is different for everyone. If you wake very early, you might want a late morning nap, otherwise the best time is between 1-3 PM (Siesta).
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Tips for sleeping well and creating a “Zen Bedroom”

Drink more water and herbal/green teas

Clean water is critical to health; purification is key. The municipal water we drink no longer is a breeding ground for diseases, but comes contaminated with chlorine and fluoride to name a few chemicals that do harm to our body. Most water in our world is contaminated with industrial, agricultural and pharmaceutical contaminants. Purify and bottle your own water for consumption. Carry your water in stainless or glass containers. Even if the plastic water bottle says it’s BPA free, it is still some kind of plastic that we will likely find out years later is toxic to some degree for our body and it leeches into your water. Airports, sport arenas, schools etc… often have filtration fill-up stations to take advantage of if you carry your own container.

Aim for drinking water before or between meals, not with your meal as it dilutes your digestive power. Skip the sugar laden drinks, juices, pop, energy drinks…. Just drink purified water and teas are best for the body. If you drink coffee, remember it’s a diuretic and acidifies the body, drink water to help off-set this, and keep coffee to a bare minimum and organic.

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Always drink clean purified water. Which water purification system to use can be complex as changes in new technology is discovered. Bare minimum use a charcoal filtration system like the common Brita filters (low end purification) or a gravity fed multi-level filtration system, alkaline systems, or reverse osmosis. My recent favourite is the Berkey Water System; check it out. If you want the cleanest water and removal of 100% glyphosates (Round-up) use reverse osmosis. For more details feel free to ask me in a visit and we can discuss. I would however suggest avoiding distilled water as it is dead and can’t hold a healthy vibration.

Water carries information and holds frequency. Dr. Masaru Emoto’s study on water structure is fascinating. I encourage you to read about his experiments on water crystalline properties. It will change how you handle and view your Drink of Life! I always put an intention or bless my water, I suggest you do the same.


Sitting is the New Smoking! Get your grove on.

The human body is designed to move. We lead sedentary lives which are having serious effects on our health. It’s evident when you see 60-70 year old people trying to get out of a chair or walk. Their strength has declined so much they have lost their vitality and ability to simply walk easily. Often their bone mass is compromised and their muscles and tendons have shortened and weakened so much they can’t straighten up. What’s most important is moving your body through space. I suggest getting up out of your chair at least every 20-30 minutes a day, the act of getting up, using your legs and sitting down with intention, not just falling into your chair is very beneficial.

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This is not new news, regular body movement is necessary for health. Movement gets your lymphatics draining, oxygenates your cells and detoxifies waste products. I am not suggesting you have to be a top athlete, however, doing active exercises you enjoy at least 3-4 times a week is critical. You don’t have to go from couch potato to marathon runner overnight.

Make it fun, some suggestions are: dancing, Tai Chi, Qigong (ask about our classes), walking/hiking, running, a sport, cycling, Yoga, dog walking, stair climbing, rebounding… Whatever is joyful and fun for you!!! Find a buddy and support each other.

Longer work outs are not better. New research shows that interval training is best for fitness, easier on your heart and overall health. This involves alternating high-burst and low-burst exercises with rest breaks. This also works out for a person with a busy schedule. A terrific workout can be accomplished in 15-20 minutes! There are loads of free exercise videos on the internet.

If you have a sedentary job, I suggest getting a sitting ball or stool to keep your core active, have a multi-level desk setting so you can stand or sit, switch back and forth. Set a timer every 30-60 minutes and get up to take a stroll, break-out into some stretches, squats, planks, push-ups etc…. Build your body strength, every little bit helps.

Nutrition – Food as Medicine

Nutrition is a huge topic which can be confusing. Paleo diet, Atkins diet, Macrobiotic diet, Ketogenic diet, Vegetarian…Truth is, information about food science that we think is correct today we may find 10 years from now was off the mark. I’ve found in 30 years of practice that everyone responds differently to food and meal plans in a very unique way. What your body needs now may also change over time, so let’s remain flexible and open making conscious choices towards honouring our body’s nutritional needs.

My approach to nutrition focuses on adding more organic, whole plant-based foods to your diet, letting go of unhealthy lifestyle practices that don’t serve you, and dialing down the stress. We won’t be counting calories or making you feel deprived or inadequate—we are done with all that. Instead I’ll encourage you create a pace that works for you as you move toward a more holistic way of living. More healthy deposits, less withdrawals is another way to look at it.

Good health starts in the kitchen!

What will always hold as a truth is that whole foods grown in healthy conditions are always are better than processed foods mass produced with genetic modified seed stock and toxic chemicals. Healthy food has a vital vibration, processed and toxic food offers no healing frequency to the body. You always have a choice, ‘God’s Garden or Man’s Lab’??

I would like to introduce the concept of being conscious of your body and it’s response to foods – get in touch with your inner wisdom, your body’s intelligence, it will steer you in the right direction every time.

In the mean time I will focus on foundational nutritional advice that generally suits everyone. As we work together, we can discover what is best for you.

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General Nutritional Suggestions

Kick the Sugar Habit

The sooner you realize that sugar is inflammatory and detrimental to your health, the sooner you

can stop damaging your system. Oh, I know this is a hard one. The human brain is wired for sugar just like cocaine. Sugar consumption is climbing out of control. Sugar is more than just empty calories, sugar literally causes heart disease, arthritis, diabetes, hormone imbalance, cancer, and more. It makes you sick!

I’m not saying you can never enjoy a sweet treat again, but do a reality check on just how much sugar you consume. You will notice a difference in how you feel once you get control of the type and amount of sugar in your diet and challenge it again, if you pay attention you will notice you feel unwell. Quitting sugar improves your health rapidly.

Sugar can be a poison – it’s all about dosage. To be clear, natural sugar found in whole fruits is okay. Don’t fall into the trap of concentrated juice to make snack foods or drinking fruit juices. I’m talking about the whole fruit!

Keep consumption of added sugar under 5 tsp daily.

Avoid: high fructose corn syrup, table sugar, artificial sweeteners, agave, rice syrup, evaporated cane juice, fructose, dextrose, maltose, sucrose, syrups, and brown sugar.

Better choices: erythritol, organic maple syrup, natural fruits, molasses, organic palm sugar, coconut sugar, monk fruit, natural honey, and stevia.

When you get the craving for sugar, stop, breath, ask yourself why you want it? Maybe learn Tapping to unlearn those old behaviours and thoughts that keep you hooked on sugar, do hypnotherapy, self-reflect on your desire for sugar, take a big glass of water and go do something you enjoy to distract you and likely the craving will pass. If not, focus on vegetables and protein to balance your blood sugar and address your nutritional needs.

Stress Reduction

Stress creates havoc on everyone’s system – full stop. Trouble is, most of us don’t even realize how much stress we are under because the busy, go-go, high achievement culture we live in has become our new normal. It is the norm to experience low-level chronic stress during our daily existence. While it’s unrealistic to eliminate all stress from your life, there are several shifts you can make to combat and reverse the negative effects of daily stress.

A person’s susceptibility to all diseases and common conditions like hormone imbalance, cancer, immune conditions, depression, anxiety, heart disease, skin conditions… are usually linked to excess stress on your system.

You can eat and exercise and do all the right things…but if you don’t take time to de-stress, you are spinning your wheels. Make time to unwind and take care of yourself, it’s truly an act of self-love.

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Stress Busters


Simply put, go outside and reap the benefits of nature. The earth has a healing frequency that influences us. As residents of this planet we thrive when we are connected to it on a daily basis. Many of us have become disconnected to our natural living environment. Most of our days are lived inside our houses, offices and schools shields us from this healing frequency.

Getting in touch with nature energizes us, resets our biological clock, and puts us in harmony with the rhythms of the earth (gravitational, seasonal, lunar, circadian rhythms) Best ways to ground your self are taking a walk in nature, walk bare foot outside, garden, imagine roots coming out from your feet going into the earth, breathing slowly and connecting to mother earth. There are many other ways, these are just a few.

Reduce toxic exposures

We underestimate the vast number of common every day household, occupational and personal care products we are exposed to every day that are TOXIC and contribute to cancer and disease. In 2 short generations we have adopted lifestyles dependent on products that cause us great harm. Industrial and agricultural practices have always contributed to our world’s toxic burden, however now, our personal choices have added considerably to the load. The human body is designed to detoxify, our healing strategies are still a working miracle, but most of us have overwhelmed our detoxification systems and the decades of bioaccumulation of toxins are doing damage to our systems.

Diseases of old age that use to be rare are now extremely common and manifesting in younger ages, even in our children we see ever growing rates of cancer and immune diseases.

You can limit your exposures where you have the ability to make conscious choices of what you buy and use in your life. Below is a short brief list of expected and unexpected toxic exposures to explore and reflect on to improve your health and reduce your TOXIC stress.

This topic is huge, whole books are written on this topic alone. You may not be able to control all aspects of toxic exposure, but you can minimize & mitigate exposures in many ways.

I encourage you to research ways to reduce your exposure or bring your questions to a visit and we can discuss viable options. TO YOUR HEALTH!

Adopt an Attitude of Gratitude

Simply put, every night before you go to bed, every morning before you get out of bed, focus on 3-5 simple things you are grateful for. Focusing on thankfulness is a positive forming habit that induces pleasure chemicals in your body.

When we train ourselves to be in gratitude, even for the little things like a cozy blanket we sleep with, we cultivate a more positive outlook on life and as a result we have less stress and attract more good things in our lives. Approach life with graceful optimism.

Honour your Body & its Innate Wisdom

Simply put, I suggest you flip your understanding of your illness or discomfort. Regard your sickness or pain as your teacher and your friend. Ask yourself why you are getting sick or feeling unwell? An illness often relates to how you are conducting your life. Have you been listening to your body signals? Have you been following the principles of nature? Have you been eating well? Have you been a happy person filled with gratitude, love, kindness and forgiveness in your heart in all situations?

Listen to your inner voice, take your illness as an opportunity, a portal to the next best version of yourself, a positive warning, a wake-up call. Your body has healing strategies, listen to its beacon for help. Your subconscious mind will express things in your body to get your attention to hold a healing space and deliver what is needed to heal mind-body-spirit.

This is the only way to really heal. If you are angry at your body for crapping out on you and you hold it in a critical way, it doesn’t have the frequency and loving support to heal. Thank your body, love your body, it’s doing the best it can under your present circumstances. Forgive yourself and move on to healing.

Now, after reading this I don’t want you to go into blame or guilt, there is no room for healing and growth there. This advice is simply offered as some guidance to become aware of what and where you are ready to grow and evolve in your own lives. Be only concerned with you and your life growth, this is what you are solely responsible for, you are not responsible for anyone else. When we grow ourselves, others around us heal and grows well, that’s the miracle.

In Love and Light,

Dr. Dawn Cormier, ND

Qigong practitioner and Reiki Healer.

Packages We Provide

Head Start Package
Adult Intake Package
Child New Patient Intake Forms