Booking Form

We use this form to help pair you with a member of our team who is the best fit for your care.

Tell Us About Yourself!

If you prefer not to use this form, please give us a call at: (604)-538-8338. We will do our best to get back to you to schedule an appointment within 2 business days. We look forward to connecting with you soon!

Step 1 of 11

Contact Info

Name

First Last

Preferred name, (if different)

Phone Number

Services

We are a multi-disciplinary practice with a team of practitioners that offer physiotherapy, registered massage therapy, yoga therapy and custom foot orthotics & bracing (Pedorthist) services.

What service are you primarily looking for?

Physiotherapy

Registered Massage Therapy

Yoga Therapy

Pedorthist - Custom Foot Orthotics and Custom Knee & Ankle Bracing

Physiotherapy - Type of Concern

Our practitioners who offer physiotherapy services each have unique professional training and skills.

To help us find the best practitioner(s) for your individual needs, select one of the options provided that best describes your needs.

What best describes your reason for booking?(Required)

Pre/post orthopaedic surgery

Orthopaedic/musculoskeletal

Vestibular / Vertigo

Scoliosis / Kyphosis Management

Cancer Rehabilitation

Pelvic Health / Pelvic Floor

Other

Pre and Post Orthopaedic Surgery

Physiotherapy can help you prepare for and recover from surgery.

What type of surgery will you be having or did you have?

When was the date of your surgery, (if multiple surgeries, date of most recent):

MM slash DD slash YYYY

Have you been to physiotherapy for this same surgery in the past?

Yes

What is your preferred time for booking?

Before 9:00am

Morning

Afternoon

After 5:00pm

Physiotherapy

Please provide a short summary of your main reason for booking. (I.e. back pain, knee pain, dizziness)

Have you been to physiotherapy for this same issue in the past?

Yes

If you are seeing us related to a surgery, what was the date of surgery?

MM slash DD slash YYYY

If you are seeing us related to surgery, what type of surgery did you have/will you be having?

What is your preferred time for booking?

Before 9:00am

Morning

Afternoon

After 5:00pm

Anytime

If you are requesting a specific physiotherapist, please write their name below.

Idiopathic and Degenerative Spinal Conditions

Combining the Integrated Systems Model and the Schroth Method; we provide physiotherapeutic treatment for patients who are suffering from structural or functional conditions.

Were you diagnosed with scoliosis by any health professional before?

Yes

Have you been to physiotherapy for this issue in the past?

Yes

What age did you receive this diagnosis? (If no diagnosis, skip to next question)

Do you remember the curve magnitude at the time of being diagnosed? (If no diagnosis, skip to next question)

What is your preferred time for booking?

Before 9:00am

Morning

Afternoon

After 5:00pm

Pelvic Health Questions

Our pelvic health team at Diane Lee & Associates consists of multiple practitioners who all have unique professional training and experience in order to provide services for a diverse group of people and their conditions / concerns.

These questions are designed to help us identify which practitioner(s) would be the best fit for your needs.

Biological Sex Assigned at Birth

The purpose of this question is to ensure we pair you with a therapist who has the training and experience for your anatomy.

Male

Female

Prefer not to answer

Gender Identity

Reason for visit (check all that apply):

Pre / Post Surgery

Diastasis Rectus Abdominus/Abdominal Wall

Bowel Concerns

Bladder Concerns

Sexual Health Concerns

Prolapse

Pelvic Pain

Proactive / Wellness

Menopause

Perinatal

Other

If you are seeking physiotherapy related to a surgery, what is the planned date of your surgery OR when was your most recent surgery?

MM slash DD slash YYYY

If you are seeing us for pre/post surgery, what type of surgery did you have?

If you are currently pregnant, what is your expected due date?

MM slash DD slash YYYY

If you have delivered a baby in the last year, what was your delivery date?

MM slash DD slash YYYY

If you have delivered a baby in the last year, did you deliver via Caesarian section or vaginal delivery?

Caesarian section

Vaginal delivery

Have you been to physiotherapy for this issue in the past?

Yes

If you have been referred by a physician or specialist, please provide their name.

If you have been referred to or are requesting a specific therapist, please write their name below.

What is your preferred time for booking?

Before 9:00am

Morning

Afternoon

After 5:00pm

Anytime

Registered Massage Therapy - Type of Concern

Massage therapy can be helpful and effective in the treatment of many common conditions. When required, a collaborative approach is used that includes Physiotherapy, Yoga Therapy and/or Pedorthics to optimize your recovery.

Reason for visit (check all that apply)

Prenatal / Post Partum

Scoliosis

Pre / Post Surgery

Muscle Pain / Discomfort

Headaches

Recovery for Sports and Activities

Back / Neck / Shoulder Pain

Other

What is your preferred day/time for booking?

Tuesday 1:30pm - 7:30pm

Wednesday 7:00am - 1:00pm

Saturday 8:00am - 2:00pm

Have you been to massage therapy for this issue in the past?

Yes

Yoga Therapy Booking

Where did you hear about Yoga Therapy?

What are you looking to achieve through Yoga Therapy?

Have you been to a yoga therapist previously?

Yes

Pedorthist Booking

What product are you looking for? (Knee Brace, Custom Foot Orthotics, Inserts etc.)

Do you have any of the following insurance providers: RCMP, Canadian Armed Forces, Veterans Affairs, ICBC, WCB, First Nations Health Authority, Disability or Ministry Assistance?

Yes

What is your preferred time for booking?

Pedorthist services are available on: Tuesday: 8:00am - 1:00pm Thursday: 8:00am - 6:00pm

Click submit to finish

Phone

This field is for validation purposes and should be left unchanged.

Booking Form

Tell Us About Yourself!

Contact Info

Services

Physiotherapy - Type of Concern

Pre and Post Orthopaedic Surgery

Physiotherapy

Idiopathic and Degenerative Spinal Conditions

Pelvic Health Questions

Registered Massage Therapy - Type of Concern

Yoga Therapy Booking

Pedorthist Booking

Links

Services