Forms & Policies
If you are a FIRST TIME CLIENT, you need to review our policies and fill out some forms.
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Intake Forms for New Clients:
If possible forms 1, 2 & 3 are to be completed before you arrive.
Please arrive 15 minutes prior to your scheduled appointment to complete your paperwork.
Form 1 – Click Here For Confidential Patient Case History Form
Form 2 – Click Here For Consent For Assessment and Treatment of Sensitive Areas Form
Form 3 – Click Here For Our Missed Appointment & Cancellation Policy
Due To The Increased Number Of Missed Appointments The Following Policy Is Effective Immediately:
You must give at least 24 hours advanced notice or you will be required to pay half the cost of the treatment as booked.
Intake Forms for New Clients:
If possible forms 1,2,3 & 4 are to be completed before you arrive.
Please arrive 15 minutes prior to your scheduled appointment time and call us at 905-725-8177 and someone will come out to your car to assist you.
Form 1 – Click Here For Confidential Patient Case History Form
Form 2 – Click Here For Consent For Assessment and Treatment of Sensitive Areas Form
Form 3 – Click Here For Our Missed Appointment & Cancellation Policy
Form 4 – Click Here For Our Covid-19 Form
Due To The Increased Number Of Missed Appointments The Following Policy Is Effective Immediately:
You must give at least 24 hours advanced notice or you will be required to pay half the cost of the treatment as booked.
Our Therapists Can Treat:
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Stress
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Fibromyalgia
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Whiplash
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Muscle Spasms
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Joint Pain
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Cold Sores
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Trauma
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Sports Injuries
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Repetitive Strain Injuries
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Chronic Pain
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Low Back & Neck Pain
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Cervical Tension
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Headaches
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Wound Healing
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Planter Fasciitis
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Acute Pain
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Autoimmune Diseases
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Degenerative Conditions
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Skin Conditions
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Fractures
& Much More…
Gift Certificates Available!
Contact us for more information.
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Mirka’s Therapeutic Health & Laser Clinic
242 Bloor St. E, Oshawa , ON L1H 3M6
email: mirka.m@rogers.com
Phone: 905-725-8177 | You can also text us at 905-439-2638 to book an appointment.