Forms & Policies

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

Forms and Policies Main Image
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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 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

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 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

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:

  • 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