📋 NEW PATIENT APPLICATION

Privacy

This encrypted, secure web form is used in accordance with Ontario’s Personal Health Information Protection Act (PHIPA). Your submission is confidential and used only to assess fit, coordinate next steps, and support your care if you proceed with our clinic.

👋 Hello & Welcome

It looks like you may be looking for support with perimenopause, menopause, hormone health—or simply feeling more like yourself again.

This application is your first step toward care with Dr. Kara Dionisio, ND. It helps us understand your needs and determine whether our clinic is a good fit before booking.

📍 Practitioner Availability

Dr. Kara Dionisio, ND

In-person in📍OWEN SOUND📍
Offers virtual care across Ontario

Dr. Bronwyn Hill, ND

Currently on leave and not accepting new patients at this time

❓ Why Do We Have an Application Process?

We use this form to make sure your health concerns align with the type of care we offer—and to help you feel informed and confident from the start.

It’s also a way for us to be transparent about how our practice works, so you know what to expect before booking.

🔄 How the Application Process Works

Once you submit your application, Dr. Kara Dionisio, ND will review your information. If it appears that our clinic is a good fit for your needs, a member of our team will contact you within approximately 7 days to discuss next steps and booking options.

🔐 Important Information About This Form

Submitting this application does not:

• Create a clinician–patient relationship
• Provide medical advice, diagnosis, or treatment
• Guarantee acceptance into the practice

Purpose
The information you provide helps us assess whether our services are an appropriate fit for your needs and determine the most suitable practitioner. Your application will be reviewed by Dr. Kara Dionisio, ND and may be accessed by authorized administrative staff for coordination purposes.

Privacy & Retention
Your personal information is collected, transmitted, and stored securely in accordance with Ontario's Personal Health Information Protection Act (PHIPA). The information provided in this application is used solely to assess clinical suitability and determine next steps.

If you choose to proceed with care, relevant information may be incorporated into your medical file. If you do not proceed with care, your application information will be retained only as long as necessary for administrative and legal purposes and then securely deleted.

Questions About Privacy
For information about how we collect, use, store, and protect personal information, please review our Privacy Policy. If you have questions or concerns, please contact us before submitting this application.

If it looks like we're a good fit to work together, you'll be invited to complete a comprehensive intake form before your first appointment.

💡 We're almost there...just a bit more information...

💳 Investment

Visits with a Naturopathic Doctor are not covered by OHIP, but many private insurance plans offer partial or full coverage. Please check your individual plan for details, including annual or per-visit limits.

The number and frequency of appointments will be tailored to your health needs and discussed during your consultation.

Current Fees:

Initial Visit (60 min): $375
Second Visit (45 min): $275
Standard Follow-Up (30 min): $185
Brief Check-Ins (10–15 min): Available if appropriate

🔁 Cancellation Policy

We require at least 48 hours’ notice for cancellations:

Late cancellations: 25% of the visit fee
Missed appointments: 50% of the visit fee

🧪 Laboratory Testing

Lab testing may be recommended to assess your health. If you have recent results from your MD or NP, further testing may not be needed.

Tests ordered through our clinic are not covered by OHIP but may be reimbursable through extended health benefits. Fees are set by LifeLabs and charged to your card on file once results are received.

💊 Hormone Therapy

Naturopathic Doctors in Ontario have some but limited prescribing rights. If hormone therapy is part of your care plan, prescriptions may be accessed through:

Collaboration with your MD, NP, or specialist
Co-management with a Nurse Practitioner working alongside our team (note: NP services are not covered by OHIP and carry an additional fee)

If hormone therapy is your main reason for seeking care, please contact our Office Manager, Lisa, before booking to ensure our model is the right fit for you.

📋 NEW PATIENT APPLICATION

Do you prefer in-person or virtual appointments

In person (Owen Sound)

Virtual

Mix of both

Age

First name

Last name

Email address

Phone number

*Please leave us the most appropriate number to call you at

City & Province where you live

*Please note, we can only see patients currently located in Ontario

How did you hear about Dr. Kara Dionisio ND & Associates? Were you referred by a health professional?

Do you have a Primary Care Provider (e.g. family doctor, or nurse practitioner)?

Yes

Other

Please tell us about your main health concerns

Please check any relevant health concerns you would like to address:

Perimenopause, Menopause & Midlife Health

Hormone Therapy

Interested in learning about or currently using menopausal hormone therapy. Please note that Naturopathic Doctors in Ontario have limited prescribing authority. Please review the information above regarding hormone therapy and prescribing options.

Hormone & Reproductive Health

Examples: menstrual cycle concerns, PMS, PCOS, endometriosis, and other reproductive hormone concerns

Vaginal or Sexual Health

Examples: vaginal dryness, discomfort, painful intercourse, libido concerns, or recurrent urinary symptoms

Healthy Lifestyle and Prevention

Examples: healthy aging, lifestyle guidance, prevention, and support during perimenopause and menopause

Other Women's Health Concern

e.g. Please describe below

Before You Start
This form is used solely to assess clinical suitability and determine next steps. Please do not include detailed medical history or sensitive health information here. If it looks like we're a good fit to work together, you'll be invited to complete a comprehensive intake form before your first appointment.

What are your top 1-3 health concerns or goal that you would like us to help you address?"

What has been the biggest challenge in getting help for these concerns or reaching your health goals?

If it looks like our clinic is a good fit for your needs, what would you like to do next?

○ I'd like to book an initial appointment. ○ I'm not able to commit at this time. ○ I have additional questions before deciding.

Do you have any questions, concerns, or comments?

Please check this box if you would like to be added to our email list for updates about women's health related courses, webinars, and group programs.

Your information will be encrypted.