Online Forms

Patient Intake Form

To apply to be a patient at one of our clinics, fill out this form and return to us via email at: hello@evolvealliedhealth.ca or in person at your location of choice. 

ADHD Self Report

The Adult ADHD Self-Report Scale Symptom Checklist is a self-reported questionnaire used to assist in the diagnosis of adult ADHD. Please download this form and return as instructed by your Family Doctor. 

EDPS (Perinatal/Postnatal Depression)

The Edinburgh Postnatal Depression Scale (EPDS) is a set of 10 screening questions that can indicate whether a parent has symptoms that are common in women with depression and anxiety during pregnancy and in the year following the birth of a child. Please download this form and return as instructed by your Family Doctor. 

MDQ

The Mood Disorder Questionnaire is a self-report questionnaire designed to help detect bipolar disorder. Please download this form and return as instructed by your Family Doctor. 

PHQ-9/GAD-7

The GAD-7 is a measurement for Anxiety Disorders and the PHQ-9 is a measurement for Depression. The PHQ-9 and GAD-7 are designed to facilitate the recognition for depressive disorders and anxiety disorders respectively. Please download these forms and return as instructed by your Family Doctor. 

Referral Form

Please have your healthcare provider use this form for any referrals to our Sports Medicine providers. Please fill out and fax to: 250.712.4968

ADHD and Mensus Info

Information regarind ADHD and the menstural cycle. Please download for your information.

Bacterial Vaginosis Info

Information regarding the treatment and prevention of Bacterial Vaginosis. Plese download for your information. 

Hirsutism Info

Information regarding Hirsutism. Please download for your information. 

IUD After Care

Things to watch for and post-IUD care information.

IUD Prep Sheet

How to prepare for your IUD appointment. 

Nexplanon Prep Sheet
 

How to prepare for your Nexplanon appointment.

PCOS Handout

Information regarding Polycystic ovary syndrome. Please download for your information.

Post Insertion Info

Post IUD insertion care and information.

Vulvar and Vaginal Pain Treatment

Information regarding the care and treatment of vulvar and vaginal pain. 

Vulvodynia Patient Info

Information regarding Vulvodynia treatment and care. Please download for your information.