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Episodic Care​

Episodic Care

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Episodic Care

Intake Form (For All Patients)

All patients, including those on the membership waitlist and those seeking episodic care, must complete an intake form. This form helps us gather essential information about your health needs.

Why choose Us

When to Complete the Intake Form:

Membership Waitlist Patients

Once notified that a membership spot is available, you’ll be asked to complete the intake form to finalize your registration.

Episodic Care Patients

For virtual care, minor illnesses, prescription renewals, or specialized services, complete the intake form to book your appointment directly—no need to join the waitlist.

Exclusive Benefits

Includes 8 appointments annually for in-person or virtual care.

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  • Monday - Thursday
  • 08.00 AM - 20.00 PM
  • Friday - Saturday
  • 08.00 AM - 16.00 PM
  • Sunday
  • Closed

Call Us

(+021) 123 662

Email Us

contact@domain.com

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Intake Form​

Please fill out the form to the best knowledge, that we may better assist you.

*For Client Reference (Form from Cortico Health Technologies goes here)*

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Become a member today or fill out the episodic care intake form

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Episodic Care