Everyday Wellness Intake

The Everyday Wellness Intake is the form-based first step before your initial consultation at Upper Room Clinic. It collects your medical history, current concerns, prior workups, lifestyle factors, and goals so that your consultation time is focused on care, not paperwork.

What the intake covers

Personal and contact details
Family medical history
Current medications, supplements, and prior treatments
Recent bloodwork, imaging, and specialist reports (uploadable)
Sleep, nutrition, stress, movement, and environmental review
Symptom history with timeline
Treatment goals and expectations

Why we ask for this in advance

A 60-minute consultation runs out quickly when 30 of those minutes are spent collecting information that you could have shared up front. Submitting your intake before your appointment lets our medical team review it ahead of time, identify any preliminary testing, and use the consultation for actual care planning.

Privacy

Intake information is handled per Canadian PIPEDA and Ontario PHIPA standards. See our Privacy Policy for full details on how we collect, use, retain, and protect your personal health information.

No items found.

Don't have a consultation booked yet?

No items found.

During Treatment

Book your initial consultation through the Upper Room Clinic Toronto patient portal, then complete the intake before your visit. If you've already booked a consultation and need to complete or update your intake, you'll find the form in the email confirmation we sent or by contacting our team directly.

Still have questions?

We would love to hear from you. It’s our pleasure to answer any questions you may have. Drop us a message below!

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Locations
Upper Room Clinic – Oakville
Tel: 647-910-5359
Fax: 289-644-0255
oakville@upperroomclinic.com

Upper Room Clinic – Davisville
Tel: 647-521-8024
Fax: 647-348-8024
hello@upperroomclinic.com

Tuesday to Saturday
11am-6pm

Quick Links

Services Programs locations PRICING ABOUT US

Stay connected

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.