Patient Forms

Once you have made your appointment, the following documents will help assist you in expediting the initial registration process. For new patients, we ask that you first download the Patient Questionnaire & Consent Form, print it off, and then fill out the required information. Please be sure to bring your completed forms with you on your first visit.

Questionnaire & Consent Form

This form must be filled out and completed before your initial consultation. It requires information on your medical history (including a printout from your pharmacy of your medication history for the last two years).  It also includes details on our policies and procedures, and a consent to disclose medical information waiver.

Click here to download

If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

ADDRESS
800 John Marks Ave 
Kingston, ON  K7K 0J7
CONTACT
regen@kopi.ca
(613) 985-7836
FOLLOW
HOURS
MON-FRI:  8AM - 5PM

SAT-SUN:  CLOSED