Body Mind Health

Intake Form

Instructions & Download Link

Click the link below to download the intake form. Then submit your form to me. There are several ways to fill in and send back a PDF form, here are 3 (I'm happy to snail mail it to you if this is too complicated!.)

Pick ONE option:

1. Fill in the form using mobile device or computer,print and sign the last page, scan the last page, and send both files back to me via email.

2. Fill in the form on your computer (doesn't always work on a mobile device) using the free Acrobat reader, digitally sign it, and email it to me . Info on digitally signing here. NOTE: YOU MUST DOWNLOAD the file to your computer in order to use the digital signature feature. This will not work in a web browser.

3. Print entire form, fill it in, then scan and email it to, or mail it back to me at: Angela Poch, 3996 Galloway Frtg Rd, East Kootenays BC V0B1T2. Be sure you allow 10 days from the time you mail it till your intake session appointment time (so receive the document before your session).

If you have any questions about how to fill out this form please feel free to email me.

intake form button

Need more help with the intake form? Watch the video below.