Please write your First, Middle and Last Name as they appear on your ID
The Panday Group health practitioners DO NOT bill OHIP
Accepted file types: jpg, jpeg, gif, png, pdf. Accepted file types: jpg, jpeg, gif, png, pdf.
FEES ARE TAX INCLUDED AND ARE FOR BOTH NEW & RENEWAL ONCE A YEAR.
Please provide your current place of contact in the fields below
Please place the best number our staff can get a hold of you.
Please Provide 3 Options
Click the + to add 3 options for dates and timings. Our health practitioner can call between 10 AM - 10 PM.
Check symptoms associated with your Primary Condition
Indicate level of symptom severity: Level 1 - Not Severe. Level 5 - Very Severe.
Please place your weight in pounds (lbs)
Example: 5 Feet 6 inches or 5'6"
What therapies have you tried?
Please check all that apply. Please rate the effectiveness on a scale of 1 to 3
(1 Not Effective, 2 Effective, 3 Very Effective)
Please indicate name of medication and dosage
Please describe with a total of grams per day
Patient Health Questionnaire (PHQ-9)
Over the last 2 weeks, how often have you been bothered by any of the following problems ?
GAD - 7
Over the last 2 weeks, on how many days have
you been bothered by any of the following