Forms

Opening a file: Health questionnaire and basic information

Informed consent to read and sign on site

***version française et English version ***

** You can print and bring the completed forms to your initial meeting or send them completed by email to:

info@chirodelouest.com with your first and last name

FRANÇAIS: Questionnaire-dadmission-nouveau-patient (pdf)

FRANÇAIS : Informations-nouveau-patient-ouverture-de-dossier (pdf)

FRANÇAIS :Consentement-éclairé à lire et signer lors du rendez-vous (pdf)

ENGLISH : Admission questionnaire-new-patient (pdf)

ENGLISH : Informations - new patient- file opening (pdf)

ENGLISH : Consent to read and to sign at the appointment (pdf)