The following clinic forms are available for your convenience:
If your next visit requires completion of a certain form, please print and fill it out, and bring it with you to your next appointment.
In some cases, a physician’s review of a form is not a service covered by the Sask. Health Plan. In these cases, a private fee, payable by the patient, applies. This fee will be explained and collected when you check in for your appointment. Please see the link to a fee schedule below for more details.
Pediatrics Health Questionnaire
Please complete this questionnaire prior to your Pediatrician consult.
To be filled out by your family doctor.
Temporarily unavailable as Dr. Hussein is not accepting new referrals at this time.
If you are a new patient at LIFEBRIDGE Health Centre, and have booked a Meet & Greet appointment (1st visit) with one of our providers, please complete this Health Questionnaire form and bring it to your Meet & Greet appointment.
For this Meet & Greet appointment, you will be seen by our nurse and have your health concerns screened and your health related data entered into our Electronic Medical Records (EMR). After the nurse completes this process, you will be seen briefly by your provider (Physician). A plan will be formulated for a more in depth follow up visit. If you have many concerns and suffer from chronic diseases, you will need to prepare to attend three or more separate office visits to LIFEBRIDGE Health Centre in order to have your health issues addressed in a comprehensive manner. Our goal is to care for the whole person and to do this well, it does take a number of office visits to create and begin to implement your healthcare plan.
The purpose of the Health Questionnaire is to collect a complete medical history, and therefore populate your electronic medical record with up to date, comprehensive, and accurate information. Please include as much information as possible. This form will be reviewed by your health care provider at your Meet & Greet appointment. Depending on the complexity of your medical history, your provider may request you book a Health Questionnaire visit with our nurse. The details of this visit will be explained to you at your 1st visit.
Complete Medical Questionnaire
If you are booked for a complete medical visit with your provider, please print and fill out the Complete Medical Questionnaire, then bring it to your Complete Medical visit. This form will provide your physician with an update on your most pressing concerns. If you do not bring this form, you can see your provider but your Complete Medical visit will likely need to be re-booked. Your provider cannot provide comprehensive care without having the necessary information available at the time of the visit.
In some cases, a physician’s review of a form is not a service covered by the Medical Services Branch of Sask. Health. In these cases, a private fee, payable by the patient, applies. This fee will be explained and collected when you check in for your appointment. Please see the link to a fee schedule below for more details.
Caring for the whole person.