One-on-One Mental Health Session with Dr. Christina Bjorndal

One-On-One Sessions

Dr. Chris works with patients one- on-one; however there is a wait list to see her. If you like to be added to the wait list, please first apply to be a patient using the form below.

Name*
First Last
Email*
Phone*
Would you like to receive our newsletter? (Y/N)*
Why do you want to see Dr. Chris?*
How did you hear about Dr. Chris?*
- Referral
- Internet/Google Search
- Social Media
- Event
- Books/Publications
YOUR HEALTH HISTORY
What is your stress level? Scale of 1 (lowest) to 10 (highest)*
Identify your stressors*
- Financial
- Work
- Marriage
- Health
- Family
- Spiritual
- Unfulfilled
- Other
Do you smoke? (Y/N) ; if yes, for how long & how many cigarettes in a day?*
Do you do drugs? (Y/N) If yes, what and for how long/frequency of use?*
Do you have a history of abuse? (Y/N) If yes, what and have you sought treatment in the past?*
Do you have PTSD? (Y/N) If yes, have you sought treatment in the past?*
Do you have an eating disorder history? (Y/N) If yes, what? If yes, have you sought treatment in the past?*
Have you been hospitalized for psychiatric needs? (Y/N) If yes, when and for what condition?*
Have you or are you currently receiving ECT treatments? (Y/N) If yes, how many? Date of last ECT treatment*
Are you currently suicidal or experiencing suicidal thoughts? (Y/N) If yes, are you currently in treatment?*
YOUR CORE BELIEFS
What aspects of your health are you NOT open to treating?
- Mental
- Physical
- Emotional
- Spiritual
If you checked off any aspects listed above, please explain why.
Are you opposed to any of the following treatment options?
- Diet/nutrition
- Botanical
- Herbal medicine
- Homeopathy
- Chinese Herbs
- Acupuncture
- Bach flower remedies
- Cognitive behavioural therapy
- Gestalt psychotherapy
- Mindfulness based therapy
- Addressing core beliefs
- Addressing shadow beliefs
What is your level of trust in Naturopathic Medicine? Scale of 1 (lowest) to 10 (highest)*
Your commitment level
What is your commitment level to your health? Scale of 1 (lowest) to 10 (highest)*
If your commitment is not a 10, please explain why.
Are you seeking help because you want to or someone else wants you to?*
Are you willing to commit to a minimum of 3 visits with Dr. Chris to address your concerns?*
Do you research treatment suggestions? (Y/N)*

Thank you for your submission!

Due to the high demand of Dr. Bjorndal, new patients must apply.

Dr. Bjorndal only accepts patients with a high commitment level and specific health issues. Please fill out the form and a staff member will be in contact with you to schedule with her, or with another doctor that will be better suited for your needs.

It may take us several weeks to review and decide on your submission. Upon decision, if you are accepted as a new patient it may take up to 2 months to receive a consult time.

You understand that if you are accepted as a patient, Dr. Chris may refer you to another clinician. Acceptance is not a guarantee of treatment and continued care.

One-On-One Sessions

YOUR HEALTH HISTORY

YOUR CORE BELIEFS

Your commitment level

Natural Terrain