INTEGRATED CANCER CARE · VANCOUVER, BC, CANADA
Monday–Friday 9–5   |   604-428-1991
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Patient resources

Patient Intake

Start with your basic details, share what you can, and leave the rest for a conversation with our team.

Your first step, at your pace

A simpler way to complete your intake.

Open the guided form and move through nine short sections. Your name, date of birth, contact details, acknowledgment, full name, electronic signatures and signing dates are required. Health and background questions can be skipped and discussed with our team later.

Complete intake online

Patient intake

The easiest way to get started

Complete your intake online

Complete your contact details, health care number, emergency contact, family doctor, allergy answer, and required acknowledgments, full name, signatures and signing dates. You may also share any optional health information you wish to provide. After your intake is submitted, you will have the option to send supporting medical records separately.

Section 1 of 9

About you

Your name, date of birth, health care number, address, phone and email are required. Later, you will also need to acknowledge the practice information and enter your full name, electronic signatures and signing dates. Other health and background questions can be skipped and discussed with our team later.

General information
Contact details
Section 2 of 9

Your background

An emergency contact name, relationship and phone are required. Other background questions can be skipped.

Emergency contact
Lifestyle
Last degree completed
Status
Electronic communication preferences

These choices are optional and separate. You may change or withdraw your consent by contacting the clinic. Please do not send sensitive medical details by email or text message.

May LEMMO contact you by email about appointments and your care?
May LEMMO contact you by SMS/text message about appointments and your care?
Reason for visit
Section 3 of 9

Medical history

Include names, doses and dates where you know them. These questions are optional; leave anything you do not know or prefer to discuss with the clinic blank.

Medical history
Have you had any surgeries, including appendix or wisdom tooth removal?
Have you had any significant accidents or physical trauma?
Do you have any other medical conditions?
Treatments and medicines
Are you currently taking any medications?
Are you currently taking any vitamins, supplements or natural health products?
Family history
My family has a history of
Section 4 of 9

Your care team

Family doctor first name, last name and phone are required. If you are under the care of an oncologist, that name is required. The allergy question is required; choose No if you have none. Checkup dates and the other questions in this section can be left blank.

Medical checkups
Have you seen a naturopathic doctor before?
Oncology care
Are you currently under the care of an oncologist? *
Have you ever received treatment for cancer?
Additional medical information
Do you have any allergies? *
Have you had any serious infections, such as TB, mono, pneumonia or chronic bronchitis?
Have you had long visits or lived in another country?
Do you use any of these?
Section 5 of 9

Daily health

These optional answers help us understand your current symptoms and routines. You may skip this section.

Sleep and activity
Do you have difficulty with sleep?
Do you remember nightly dreams?
Symptoms
Changes in weight during the past 6 months?
Have you experienced nausea or vomiting?
Do you suffer from pain?
Fevers or night sweats during the past week?
More about your health
How do your bowels currently work?
Do bathroom visits interrupt your sleep?
Are you currently taking painkillers?
How often have you had colds or flu?
How often do you receive the flu shot?
Have you received the COVID-19 vaccine?

If you have been diagnosed with cancer, answer the colds-or-flu question for the time before your diagnosis.

Section 6 of 9

Practice information

Please read this statement and confirm the acknowledgment. Your full name carries over from About you. Confirm your electronic signature using the button or type it, then enter the signing date. These fields are required.

About Dr. Lemmo's practice

Dr. Walter Lemmo is a licensed naturopathic physician (ND) with over 25 years of experience in integrative cancer care. Because our approach integrates experience-guided and evidence-informed naturopathic therapies with conventional cancer treatments, some members of the standard oncology community may have differing opinions or may not support all of Dr. Lemmo’s recommendations.

We respect that there are many perspectives in cancer care. Our goal is not to create conflict or debate, but to support you in making informed choices that feel right for your situation. Dr. Lemmo encourages every patient to trust their own intuition and to choose the path that brings them the greatest sense of comfort and the least amount of fear and stress.

Collaboration with your oncology team: Dr. Lemmo is always available to speak directly with any member of your healthcare team (oncologist, haematologist, nurse, pharmacist, nurse practitioner, medical doctor, naturopathic physician, etc.) if questions or concerns arise. Please have your team contact the office by telephone at the earliest opportunity. Email, social media, or mailed letters are not suitable for urgent clinical discussions.

By signing below, you confirm that you have read and understood this information.

I have read and understood this statement *
Section 7 of 9

Fees and research

Read the financial policy, then enter your electronic signature and signing date. Both are required. The research choice is optional; leaving it blank means no research consent is supplied.

Financial policy · updated July 2026

All services are provided by Dr. Walter Lemmo, ND, and Lemmo Integrated Cancer Care Inc. in the Province of British Columbia, Canada. Dr. Lemmo is licensed by the College of Complementary Health Professionals of British Columbia (CCHPBC).

Governing law: This agreement and all aspects of care are governed by the laws of British Columbia and Canada.

Consultations: First consultation (about 60 minutes): $350. Follow-up consultations (about 30 to 60 minutes): $225. Brief consultations: $150.

Extended health plans: Extended health insurance, where applicable, may cover all or a portion of the fees. Most extended health insurance plans offered by large corporations will have some coverage for naturopathic services. Please check with your particular carrier for its policies on coverage.

Other costs: All tests, treatments, and remedies are not covered by MSP (costs will vary). A 24-hour notice is required for cancellations or you will be billed $30.00 for each missed visit. NSF cheques are charged at $50.00 as a processing fee for each NSF cheque. The clinic reserves the right to change fees at any time. Please contact the clinic directly by phone or email to receive the latest information.

Research consent

There may be noteworthy findings, treatment results or outcomes that occur under the supervision of Dr. Lemmo, which could benefit future patients and the scientific research community if they are made aware. By being a patient of Dr. Lemmo, you are asked to provide consent for Dr. Lemmo to use certain aspects of your medical data for scientific research and the potential publication of such research. In any event, your personal information, such as your identification and contact information, would be kept strictly confidential as part of standard medical research guidelines.

By signing below, you indicate that you have read and understood this financial policy and agree to pay for the products and services outlined.

I consent to participating in research
Section 8 of 9

Records release

If you do not need LEMMO to request records, select “No records to request at this time.” Otherwise, identify the provider, select the records, authorize their release, and sign and date the request.

Records request
No records to request at this time
Request destination

Please send the requested records to Dr. Walter Lemmo, ND, at LEMMO Integrated Cancer Care Inc., Suite 205, 3900 Hastings Street, Burnaby, BC V5C 6C1. Fax: 604-428-1992.

Patient information
Records requested
Section 9 of 9

Review and send

Check your contact details, health care number, emergency contact, family doctor, allergy answer, acknowledgment, full name, electronic signatures and signing dates before submitting. Other health questions may be left blank. Your research choice is separate from signing the financial policy; leaving that choice blank supplies no research consent.

Send and keep a copy

Please review the privacy policy before sending medical information.

After a successful submission, your completed PDF download starts automatically. Save it to your computer for your records. The clinic email subject includes your last name and date of birth so the team can identify your form.

You can close and reopen the popup without losing your answers while you stay on this page. Answers are not saved if you refresh or leave.

PDF option

Prefer to use the fillable packet?

The 11-page packet includes your health history, acknowledgments, financial policy, and optional records release. On a phone or tablet, we recommend using the online intake form instead. The fillable PDF works best on a computer or when downloaded and opened in Adobe Acrobat Reader.

Download blank PDF

Fillable patient intake PDF
  1. Complete your intakeMove through the guided sections at your own pace.
  2. Submit and keep a copySubmit your intake and save the completed PDF that downloads automatically.
  3. Send records if neededAfter your intake is submitted, you can separately send supporting medical records for the clinic to review.
Finished filling out the PDF? Upload and send it securely here (click here)
Send your completed packet

Submit intake and supporting files

Files are sent together in a password-protected package to the clinic. The email subject includes your last name and date of birth so the clinic can identify your submission.

Please review our privacy policy before sending medical information.

LEMMO Integrated Cancer Care
We’re here to help

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be a beginning.

Have a question about our care or becoming a patient? Our team can explain your first visit and help you take the next step.

Let’s talk about your next step

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For appointments and general enquiries. Leave us a message and our team will be in touch.

Call our team
604-428-1991
Email us
info@lemmo.com
Visit our clinic
Suite 205, 3900 Hastings Street
Burnaby, BC V5C 6C1
Office hours
Monday–Friday
9:00 am–5:00 pm
By appointment

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