Memberships and Programs Intake

The Memberships & Programs Intake is the form you complete to be matched into the right Upper Room Clinic care program — Detoxification, Heal & Regenerate, Immune Defense, Mitochondria Renew, Weightless & Energized, or one of our membership tiers.

What the intake covers

  • Personal and contact details
  • Health goals and primary concerns
  • Current and recent medical care
  • Prior testing and treatment history
  • Lifestyle and schedule constraints
  • Program preferences and expectations

How program matching works

After you submit, our medical team reviews your intake against the program criteria and recommends the best fit. Some patients are best served by a specific testing-and-therapies program; others by a tiered membership; others by a custom care plan that doesn't fit a packaged program. We'll tell you honestly.

What if I'm not sure which program is right?

That's the point of the intake — you don't have to know. We match. If you'd prefer to talk first, book an Everyday Wellness Consultation and we'll discuss program options together.

See our Testing and Therapies hub for the current program list, and our Memberships page for tiered ongoing care.

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Privacy & next steps

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During Treatment

Intake information is handled per PIPEDA and PHIPA. See our Privacy Policy for full details. Submit your intake online to start the matching process, or contact Upper Room Clinic Toronto if you need help with the form.

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!
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Contact Us

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

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