Forms & Policies

If you are a FIRST TIME CLIENT, you need to review our policies and fill out some forms.

Forms:

If you are a first time client, please complete the following forms and arrive 15 minutes prior to your scheduled appointment time.

Click Here For Confidential Patient Case History Form (Page 1)

Please download, print, fill out and bring this form to your first appointment.

Click Here For Your Health Profile Form (Page 2)

Please download, print, and bring this form to your first appointment (to be completed with your therapist).

Click Here For Consent For Assessment and Treatment of Sensitive Areas Form

Please download, print, fill out and bring this form to your first appointment.

Missed Appointments:

When you book an appointment with us that time is set aside for you – and ONLY you.

We never double book and we try to always be ready for you when you arrive.

In return, we ask that you keep your promise to us and please show up for your appointment on time.

Please understand that massage therapists only get paid when they deliver a service… therefore missed appointments are costly for us and prevent us from catering to other clients.

That said our policy is simple: if you do not show up for your scheduled appointment, and you have not notified us at least 24 hours in advance, you will be required to pay half the cost of the treatment as booked.

Cancellations:

In the event that you unable to keep your scheduled appointment with us, please contact us by phone at least 24 hours prior to your appointment.

If you do not reach us, please leave a message on our voicemail system.

If we do not hear from you within this timeframe, and you do not keep your appointment, the above policy will be applied.

Note: We recognize that no one is perfect and there are circumstances that are out of your control (sudden illness, family emergencies, etc.) and so your therapist may make an exception to the above policies on those rare occasions.

Forms:

If you are a first time client, please complete the following forms and arrive 15 minutes prior to your scheduled appointment time.

Click Here For Confidential Patient Case History Form (Page 1)

Please download, print, fill out and bring this form to your first appointment.

Click Here For Your Health Profile Form (Page 2)

Please download, print, and bring this form to your first appointment (to be completed with your therapist).

Click Here For Consent For Assessment and Treatment of Sensitive Areas Form

Please download, print, fill out and bring this form to your first appointment.

Missed Appointments:

When you book an appointment with us that time is set aside for you – and ONLY you.

We never double book and we try to always be ready for you when you arrive.

In return, we ask that you keep your promise to us and please show up for your appointment on time.

Please understand that massage therapists only get paid when they deliver a service… therefore missed appointments are costly for us and prevent us from catering to other clients.

That said our policy is simple: if you do not show up for your scheduled appointment, and you have not notified us at least 24 hours in advance, you will be required to pay half the cost of the treatment as booked.

Cancellations:

In the event that you unable to keep your scheduled appointment with us, please contact us by phone at least 24 hours prior to your appointment.

If you do not reach us, please leave a message on our voicemail system.

If we do not hear from you within this timeframe, and you do not keep your appointment, the above policy will be applied.

Note: We recognize that no one is perfect and there are circumstances that are out of your control (sudden illness, family emergencies, etc.) and so your therapist may make an exception to the above policies on those rare occasions.

Our Therapists Can Treat:

  • Stress

  • Fibromyalgia

  • Whiplash

  • Muscle Spasms

  • Joint Pain

  • Cold Sores

  • Trauma

  • Sports Injuries

  • Repetitive Strain Injuries

  • Chronic Pain

  • Low Back & Neck Pain

  • Cervical Tension

  • Headaches

  • Wound Healing

  • Planter Fasciitis

  • Acute Pain

  • Autoimmune Diseases

  • Degenerative Conditions

  • Skin Conditions

  • Fractures

& Much More…

 

 

 

Gift Certificates Available!

Contact us for more information.

Our focus has always and always will be the continued commitment to provide the best possible patient outcomes. We measure our success by how many referrals our patients bring in.

 

 Mirka’s Therapeutic Health & Laser Clinic

242 Bloor St. E, Oshawa , ON L1H 3M6
email: mirka.m@rogers.com
Phone: 905-725-8177 | Text: 905-243-1038