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 – In-Person Office Consultation or Telemedicine Written Consultation
New patients preparing for consultation at Medicor: please download and fill in these forms.
The same forms can be used for in-person or telemedicine consultation. Payment for an office consultation online before the visit results in a $50 saving. Before requesting a telemedicine consultation, please ensure that medications can be legally imported into your home country.
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.