Chiro Blend-Natural Weight Management

First Name

Last Name

Email Address

Telephone Number

Type of Booking:
—Please choose an option—Initial Consultation & Exam - $95Laser Treatment Session - 30min - $60Laser Treatment Session - 45 min - $90Laser Treatment Session - 60 min - $120

Preferred Practitioner
1st available appointmentAlain Dalida

Preferred Date

Preferred Time:
MorningAfternoonEvening

Additional Information (optional)

First Name

Last Name

Email Address

Telephone Number

Type of Booking:
—Please choose an option—Emergency Off-Site VisitTelehealth Initial ConsultationTelehealth Subsequent Appointment

Preferred Practitioner
1st available appointment

Preferred Date

Preferred Time:
MorningAfternoonEvening

Additional Information (optional)

First Name

Last Name

Email Address

Telephone Number

Type of Booking:
—Please choose an option—Initial Consultation & ExamActive RehabilitationRehabilitation

Preferred Practitioner
—Please choose an option—1st available appointmentMonika Bains

Preferred Date

Preferred Time:
MorningAfternoonEvening

Additional Information (optional)

First Name

Last Name

Email Address

Telephone Number

Type of Booking:
—Please choose an option—Initial 15 Minute Consultation & Registered Massage TreatmentNon-registered Manual TherapyRegistered Manual Therapy

Preferred Practitioner
1st available appointmentNaomi KajiwaraNikki LiangVanessa de Rooy

Preferred Date

Preferred Time:
MorningAfternoonEvening

Additional Information (optional)

First Name

Last Name

Email Address

Telephone Number

Type of Booking:
—Please choose an option—Initial Consultation & Exam (New Patients) - $95Subsequent Adjustments (Existing Patients) - $60Nerve Scan - $75Postural Analysis - $75Spinal X-Rays - $95Gait Scan - $75

Preferred Practitioner
—Please choose an option—1st available doctorDr. Charles Wang, DCDr. Gohar A. Sheikh, DCDr. Taemin (Tim) Kang, DC

Preferred Date

Preferred Time:
MorningAfternoonEvening

Additional Information (optional)