Clinic Hours & Client Forms

Nutritional Consulting Services
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Reiki Treatments
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I offer appointments at my office in Elora, Ontario
Skype or FaceTime sessions available

You can schedule your appointment by calling or texting 519-835-9856 or email jennifer@anchorwellness.com.
At this time, I am unable to accept "walk-ins".

If you require accessiblity or prefer to meet in Fergus ON, I have office privileges at:

Shift Family Health Centre
105 Queen Street, West, Unit 7
Fergus ON N1M 1S6
519-787-8111

Clinic Hours:
(By appointment only)
Monday-Friday 9:30 am-6:00 pm
Please inquire about evening/weekend appointments

If you are a new client please download and complete the Intake Form (and Nutritional Tracker if applicable) and bring them with you to your initial consultation. If you would prefer to do submit the forms electronically, they will be handled confidentially.

intake_form-anchor_wellness_copy.pdf
File Size:	21 kb
File Type:	pdf

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lsp___naf_forms.pdf
File Size:	858 kb
File Type:	pdf

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Intake form for Anchor Wellness

Date *

Name *

First

Last

Address *

Phone number *

Email *

Gender *

Male Female

Date of Birth (d/m/y) *

Are you interested in: *

Nutritional Consultation Health & Wellness Coaching Both - nutritional consultation and coaching Holistic Weight Management System Reiki Unsure

Purpose of visit/ main health concern? *

Have you been diagnosed with an illness related to your main health concern? *

Are you currently taking any medication? *

Yes No

If yes, please list medications and provide reasons: *

Please list any vitamins, minerals, herbal or homeopathic remedies you are currently taking and the amount/dosages: *

*By submitting this form, I understand and acknowledge that these recommendations are restricted to consultation on the health matters intended for general well-being, and are not meant for the purpose of medical diagnosis, treatment or prescribing of medicine for disease, or for the purpose of performing a licensed or controlled act which may constitute the practice of medicine. This statement is being submitted voluntarily.

Submit