Direct Billing, Edmonton Massage, Massage Edmonton, Edmonton Chiropractor, Chiropractor Edmonton, Acupuncture Edmonton, Edmonton Acupuncture, holistic nutrition, reflexology, Naturopathic Edmonton, Osteopath Edmonton
Direct Billing, Edmonton Massage, Massage Edmonton, Edmonton Chiropractor, Chiropractor Edmonton, Acupuncture Edmonton, Edmonton Acupuncture, holistic nutrition, reflexology, Naturopathic Edmonton, Osteopath Edmonton

Purity Health & Wellness 

Massage. Chiropractic. Acupuncture. 
Naturopathic Medicine. Reflexology.

Intake Paperwork 

Please print and fill out the corresponding intake paperwork and bring it with you to your appointment. 


***If you are unable to do so, the intake paperwork will be provided to you prior to your appointment start time. Please plan on arriving 10 Minutes prior to your scheduled appointment to allow time to fill out all documents. Thank you. 


Massage Intake Form


Hot Stone Massage Consent Form 

(Massage Intake Form must also be filled out if this is your first massage)


Chiropractic Intake Form


Acupuncture Intake Form Female


Acupuncture Intake Form Male


Naturopathic Intake Form


Prolotherapy/Neural Therapy Intake Form


Constitutional Facial Rejuvenation Acupuncture Intake Form


Reflexology Intake Form