Pre-Assessment Health Questionnaire

• Your information is stored securely on Canadian servers(Montreal, Canada) in compliance with Nova Scotia's health-privacy legislation (PHIA & PIPEDA).
• Your submission is automatically deleted 30 days after it is delivered to the clinic. Signature Health keeps your assessment record in their Electronic Medical Record System.
• You can withdraw consent at any time. If you'd rather not use this online form, you can download a PDF to fill out by hand instead: new client questionnaire or returning client questionnaire.

Your answers are saved in this browser as you go, so you can finish later on the same device — please avoid public or shared computers, and your saved progress is cleared once you submit.

By continuing, you consent to Signature Health collecting and storing the information in this questionnaire for the purpose of your assessment. Read our privacy policy.