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Moncton Naturopathic Medical Clinic
Dr. Martin Gleixner, MSc, ND - Naturopathic Doctor
Ph: 506-382-1329/ Fax: 506-382-1828

Forms

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Please download the intake form prior to your appointment. 


Successful health care and preventive medicine are only possible when the doctor has a complete understanding of the patient physically, mentally and emotionally.  Your time, thoughtfulness and honesty in completing this overview will greatly aid me to assist your health needs.


Please bring your intake forms, consent forms and copies of any recent blood work or imaging tests to your first visit.  If you are unable to complete the form prior to your visit, please arrive 45 minutes earlier to complete the form.

Adult Intake Form

Pediatric Intake Form (6-12 years)

Pediatric Intake Form (Birth - 5 years)

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