This page provides links to Medicor Cancer Centre’s “fillable” PDF files which can be downloaded, filled in and returned to Medicor. Completed forms can be faxed back to us at +1-416-227-1915, emailed, or printed and sent by mail.
New Patient Forms – Office Visit
New patients preparing for consultation at Medicor: please download and fill in these forms.
As of August 2017, we no longer offer telemedicine consultation.
DCA Consent Form
If you have cancer and wish to be treated with with Sodium Dichloroacetate (“DCA”), please download and complete this form.
LDN Consent Form
If you have cancer and wish to be treated with Low Dose Naltrexone (“LDN”), please download and complete this form.
USA Insurance Billing
American patients: please fill out and submit this 2-page form to AMHA if you wish to have them bill your insurance company on your behalf.