Intake Forms

Intake FormsThere are two forms that need to be completed before your first visit with Mylène.

Completing both of these forms before your first visit will save time and allow more time for therapy.

Information Sheet:

The first is a basic information sheet that consists of some simple questions and contact info.

This will need to be completed for Mylène to provide the best care possible to you.

You have three options for completing the “Information Sheet”:

  1. Complete the Online Information Sheet online and submit.
  2. Download the Information Sheet, print, complete and bring to your first appointment.
  3. Download the Information Sheet, print, complete, scan and upload to the box below.


Consent to Service:

Your privacy is very important to Mylène.

The Consent to Service is a short form that explains confidentiality and gives Mylène the consent required to provide services to you.

To save time you may Download the Consent to Service and either:

  1. Complete the form and bring it with you to your first visit with Mylène
  2. Complete the form, scan it and upload below.

* You will notice a signature line for a witness on the consent form. You can leave that blank and Mylène will sign it as you both discuss consent and confidentially during your first visit.

 


Completing these forms before your first visit will save time and allow more time for your therapy.

If you have any questions please do not hesitate to email Mylène at mylene@mylenedeveau.ca or call 506-866-3989.

Thank you so much!