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 & 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.

 

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:

  • 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…

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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 | Text: 905-243-1038