Get a head start on your first visit.

Answer a few questions and we'll prepare a summary for our team — so your appointment time goes to treatment, not paperwork.

This form is for pre-visit planning only — it isn't monitored for urgent messages. If you have severe or worsening symptoms, chest pain, or numbness, call 911 or your doctor. Your answers are used only to prepare for your visit. Your health answers — not your name or contact details — are summarized by OpenAI's AI service, and your answers are emailed to our clinic team through Resend; both process information in the United States. See our Privacy Policy.

First name

Last name

Email (optional)

Phone (optional)

What brings you in?

Tell us about your main concern

When did it start? (optional)

Pain level right now (0–10, optional)

What makes it better or worse? (optional)

What would you like to get back to? (optional)

ICBC claim number (if any)

I agree to send these answers to Kinetic Therapy Clinic to prepare for my visit. I understand my health answers (not my name or contact details) are summarized by OpenAI's AI service, that my answers are emailed to the clinic through Resend, that both process information in the United States, and that this form is not monitored for urgent medical needs.

If you have urgent symptoms, call 911 or visit an emergency department.