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Bayview Village Wellness Centre 201 2901 Bayview Avenue North York ON M2K 1E6 416. 221. 7724 www. bayviewwellness. Com Dr. Ed Lubberdink D.C. Dr. Tonya Luby D.C. Dr. Amanda Graham D.C. Dr. Stacey Smith D.C. Pediatric New Patient Questionnaire Child s Name Date Parents Names Address City Postal Code Home Phone Cell Phone Work Phone Weight current Female q D. 00 for each missed appointment unless 6 hours notice is given. I have read and understood the above and will be bound to the terms and...

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