Referral Form

Please fill in all the required fields marked with asterisks (*).


  • Please tick which issues are related to this client
  • Naturopathic medicine is the art and science of disease diagnosis through blood, urine, breath and stool tests as well as treatment, and prevention using natural therapies including botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation, traditional Chinese medicine/acupuncture, lifestyle counseling, health promotion, and disease prevention.
  • An Eating Psychology Coach deals with individuals that have a poor relationship with food and poor eating behaviors such as binge eating, portion control, emotional eating and poor body image. They help to work through the emotional component of eating and food choices.



  • Family Doctor's Information

    To increase the approval rate of the assessment it is highly recommended that a family doctor provide a note indicating that the client requires nutrition services as a result of the client's mva related injuries and symptoms.
  • This field is for validation purposes and should be left unchanged.
Food Sensitivities Test 24 Common Foods Koru Nutrition
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