Dr. MacAdam & Associates
  • Services
    • Chiropractic >
      • Techniques and Therapies
      • Custom Orthotics & Footwear
    • Massage Therapy >
      • Massage Therapy Treatment Options
    • Naturopathic Medicine >
      • Vitamin & Nutrient Injections
    • TCM Acupuncture
    • Yoga
    • Mental Performance
  • SHOP
  • Book An Appointment
  • Patient Intake Forms
    • Chiropractic, Massage & Acupuncture
    • Naturopathic >
      • Adult Intake Form
  • Meet Our Team
    • Chiropractors >
      • Dr. Katherine MacAdam, BScKin, DC, MSc, ACC, FCCSS(C).
      • Dr. Maggie McKeough BSc, DC, Medical Acupunture
    • Massage Therapists >
      • Laura Dwyer, RMT
      • Cassie Hilani, RMT
      • Adam Blackwood, RMT
      • Morgan Nearing-Deveaux, RMT
    • Naturopathic Doctor >
      • Dr. Cassandra Connolly, BSc, ND
    • Acupuncturist >
      • Nicole Stallard, RAc, DAc
    • Reception Staff
  • FAQs
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Dr. Cassandra Connolly
​Child Intake Form
(6-12 years of age)

 
Dr. Cassandra Connolly, ND
6777 Quinpool Road
Halifax, NS
T: (902) 407-3347
 
Fees and Cancellation Policy 
Initial Visit - Adult w/ Dr. Connolly $180.00 
Initial Visit – Child w/ Dr. Connolly  $160.00
Subsequent visit - Adult $90.00
 
Failure to show up for scheduled appointment: Full Fee
Appointment cancelled within 24 hours of appointment: Half Fee
 
This fee is to cover the practitioner’s time, as these appointment slots will not be filled by other patients in need or on the waiting list. 
 
A minimum of 24 hours is required for the cancellation of an appointment in order to facilitate the filling of this spot with another patient.
 
While we do make every effort to contact patients in the days preceding their appointments, this confirmation should not eliminate the responsibility of the patient to take note of and attend their appointments. 
 
If you need to cancel an appointment, please leave a message on our voicemail at (902) 407-3347 or speak with the receptionist.
 
We appreciate your understanding and cooperation.

    Children's Intake Form (6-12 years old)
    Please note that this intake form will take time to complete accurately.

    Insurance

    Credit Card
    ​In order to direct bill your insurance company on your behalf we require a credit card be left on file.


    Current Health

    What are your child’s health concerns (in order of importance)?  When did they begin?
    Please indicate the date of your last:
    Medications & Supplementation(include all prescribed or over the counter drugs & supplements taken by child).
    Vaccinations: Please indicate at what age your child received the vaccination and if they had any reaction.

    Breastfeeding

    Temperature

    Perspiration

    Bowel Habits

    Sleep

    Energy Level

    Diet

    Please describe an average day:
    ​Beverages

    Environment

    Immune System

    Development

    Family History

Submit
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  • Services
    • Chiropractic >
      • Techniques and Therapies
      • Custom Orthotics & Footwear
    • Massage Therapy >
      • Massage Therapy Treatment Options
    • Naturopathic Medicine >
      • Vitamin & Nutrient Injections
    • TCM Acupuncture
    • Yoga
    • Mental Performance
  • SHOP
  • Book An Appointment
  • Patient Intake Forms
    • Chiropractic, Massage & Acupuncture
    • Naturopathic >
      • Adult Intake Form
  • Meet Our Team
    • Chiropractors >
      • Dr. Katherine MacAdam, BScKin, DC, MSc, ACC, FCCSS(C).
      • Dr. Maggie McKeough BSc, DC, Medical Acupunture
    • Massage Therapists >
      • Laura Dwyer, RMT
      • Cassie Hilani, RMT
      • Adam Blackwood, RMT
      • Morgan Nearing-Deveaux, RMT
    • Naturopathic Doctor >
      • Dr. Cassandra Connolly, BSc, ND
    • Acupuncturist >
      • Nicole Stallard, RAc, DAc
    • Reception Staff
  • FAQs
  • Contact
  • Gallery
  • Videos
  • Excercises