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MEDICAL QUESTIONNAIRES (Click here to view available forms)

  • Canadian Patient - Medical Questionnaire

    Canadian patients please download, print out and complete this form.

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  • International Patients - Medical Questionnaire

    International patients from outside Canada, please download, print out and complete this form.

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DCA THERAPY(Click here to view available forms & documents)

  • Consent and Direction for DCA Treatment

    If you have cancer and have elected to have Medicor Cancer Centres Inc., treat your cancer with the drug Dichloroacetate Sodium (DCA), please download, print and complete this form.

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  • DCA Frequently Asked Questions

    To learn more about Dichloroacetate Sodium (DCA) please click to download this document.

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  • DCA Full Package - Canada

    Treatment information and registration package for Canadian patients.

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  • DCA Full Package - USA

    Treatment information and registration package for patients from the USA.

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  • DCA Full Package - International

    Treatment information and registration package for international patients.

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LDN & OGF (Click here to view available forms & documents)

  • Consent & Direction for LDN or OGF Treatment

    If you have cancer and have elected to have Medicor Cancer Centres Inc., treat your cancer with the Low Dose Naltrexone (“LDN”) or Opioid Growth Factor (“OGF”) please download, print and complete this form.

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  • LDN & OGF Frequently Asked Questions

    To learn more about Low Dose Naltrexone (“LDN”) and Opioid Growth Factor (“OGF”) please click to download this document.

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RIBAVIRIN TREATMENT (Click here to view available forms)

  • RBV Consent form

    If you have cancer and have elected to have Medicor Cancer Centres Inc., treat your cancer with the drug Ribavirin (RBV), please download, print and complete this form.

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  • Ribavirin Frequently Asked Questions

    To learn more about Ribavirin (RBV) please click to download this document.

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TM TREATMENT (Click here to view available forms)

  • TM Consent form

    If you have cancer and have elected to have Medicor Cancer Centres Inc., treat your cancer with the drug Ammonium Tetrathiomolybdate (TM), please download, print and complete this form.

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  • TM Frequently Asked Questions

    To learn more about AmmoniumTetrathiomolybdate (TM) please click to download this document.

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INSURANCE FORMS (Click here to view available forms)

  • 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.

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