Primitive Reflexes Questionnaire

The following list of traits could indicate if you or your child have a retained primitive reflex
Please note - you need to be a patient of our clinic for us to assess your responses on this form

After you fill out your form, it will be sent electronically to us. We will have time to review your responses so we can be better prepared for your assessment.

We require your paperwork THE DAY BEFORE your primitive reflexes assessment or we will have to rebook your appointment.

Thank you!

Dr. Melanie, Dr. Laurence and Dr. Leah

If you could like to become a patient of our clinic, please call us at 403-945-2422 to book your initial appointment