We also provide specialized rehab for post cardiac by pass surgery, post knee and hip replacement, post lung transplant and for patients with COPD. Home assessments, treatments and environmental improvements are also available for seniors and patients with disability those who can not attend the clinic.
12837 88 Ave #106 Surrey, BC V3W 3K2
(778) 564-2564
8181 120a St Unit 201 Surrey, BC V3W 3P2
(778) 564-0900
Please take a moment to fill out our online intake form before you visit.All information is kept completely confidential.
Only Stoff members can edit this informatjon on on intake form.
First Name -Required
Last Name -Required
Preffered Name (if different)
Pronouns
Prefix / Title
Email -Required
Please provide at least one phone number. Your mobile number can be used to look up your Account and receive text message appointment reminders.
Mobile Phone
A mobile phone is required if you would like to receive SMS appointment reminders.
Home Phone
Country
Suite Number
City
Province
Postal / Zip
Date of Birth -Required
Gender
Refers to current gender which may be different than what is indicated on your insurance policies or medical record.
Sex
This field may be used for submitting claims to your insurance provider. Please ensure the sex you provide here matches what your insurance provider has on file or what is indicated on your medical record.
Personal Health Number -Required
Guardian
Emergency Contact
Emergency Contact Phone
Emergency Contact Relationship
Family Doctor -Required
Family Doctor Phone (if known)
Family Doctor Email (if known)
Referring Professional
Referring Professional Phone (if known)
Referring Professional Email (if known)
How did you hear about us?
Who were you referred to?
You are completing the following intake forms: Intake form (September 2023)
Insurer
You are completing the following intake forms: Intake form (September 2023) Communication
You can opt to receive emails to keep you informed of new bookings, changes to your bookings, and reminders for upcoming appointments.
Email
Email 24 hours before appointment
Text message (SMS)
Standard messaging & data rates may apply, messaging frequency can vary and you can update your preferences anytime.
Text Message (SMS) 24 hours before appointment
Phone call
Phone Call 24 hours before appointment
News and Special Promotions
Yes, I would like to receive news and special promotions by email
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