Online Forms for Patients of the Matrix Wellness Centre

New Patients
Please fill out this New Patient online form if you have booked your first appointment with a Matrix Repatterning practitioner.
If you don’t wish to fill out & submit the form online, please print this PDF version, fill it out by hand, and bring it with you to your first appointment. 

New Patients (under 12)
Please fill out this Children's Health Questionnaire online form if you have booked your first appointment for a child 12 and under.
If you don’t wish to fill out & submit the form online, please print this PDF version, fill it out by hand, and bring it with you to your first appointment.

If you need Adobe Reader to view PDF forms, download it here.