Dr. Benna Lun BSc(Hons) ND
Copyright 2015 by Bena Lun, ND. All Rights reserved. Contact:  E-mail
Naturopathic Doctor
 
SERVING:
Niagara Falls • Niagara-On-The-Lake (NOTL) • St. Catharines • Thorold • Queenston • Fort Erie • Ridgeway • Stevensville • Crystal Beach • Port Colbourne • Welland
Buffalo • Lewiston • Tonawanda • North Tonawanda • Niagara Falls, NY
NIAGARA FALLS
6150 Valley Way, Niagara Falls, ON

FORT ERIE REGION
355 Ridge Rd. N, Ridgeway, ON


Phone: (Toll-Free) 1-888-550-5303
E-mail: DrLun.ND@gmail.com
New Patient Forms

Please print the forms below (Naturopathic Consent Form AND Age-Appropriate Intake Form) and bring them
to your first appointment OR request a copy to be picked up at the clinic OR arrive 30 minutes prior to your
scheduled appointment and fill them out at the clinic.

The information from these forms will aid Dr. Lun in assessing your case and save valuable appointment
time. Please call 1-888-550-5303 or send an e-mail if you require assistance downloading or completing the
forms.
Ridgeway Wellness Centre
Naturopathic Consent Form:
RWC - Consent to Naturopathic Treatment

Patient Intake Form:
RWC - Pediatric (Age 0-12) Intake Form
RWC - Youth (Age 13-16) Intake Form
RWC - Adult (Age 16+) Intake Form
Niagara Falls Chiropractic Clinic
Naturopathic Consent Form:
NFCC - Consent to Naturopathic Treatment

Patient Intake Form:
NFCC - Pediatric (Age 0-12) Intake Form
NFCC - Youth (Age 13-16) Intake Form
NFCC - Adult (Age 16+) Intake Form