• Image field 128
  • Sex

  • How would you like to be reminded of future massage appointments?
  • Have you received massage therapy before?
  • Did a health care practitioner refer you for registered massage therapy?
  • Please check off any of the conditions below that you are experiencing, have experienced, or a close relative has suffered from:
  • Cardiovascular:
  • Respiratory
  • Infections
  • Other Conditions
  • Loss of sensation
  • Allergies/Hypersensitivity
  • Epilepsy
  • Cancer
  • Skin Condition
  • Arthritis
  • Is there a family history of Arthritis?
  • Head/Neck
  • Women
  • Pregnant?
  • Gynecological conditions?
  • General Health Questions
  • Are you currently receiving treatment from another health care professional?
  • Surgeries
  • Injuries
  • Do you have any other medical conditions? (e.g. digestive conditions, hemophilia, osteoporosis, mental illness)
  • Do you have any internal pins, wires, artificial joints or special equipment?
  • What is the reason you are seeking massage therapy?
  • Registered Massage Therapy Payment & Cancellation Policy
     
  • Payment is due at the time of your appointment. Please note that registered massage therapy is not covered by OHIP. However, many private health insurance plans do include coverage for registered massage therapy services. We recommend checking with your insurance provider to confirm your specific coverage details and whether a referral from a medical doctor is required for reimbursement.

    If you need to cancel or reschedule your appointment, we kindly ask for a least 12 hours’ notice. Cancellation made with less than 12 hours’ notice, or missed appointments, will be subject to a $75.00 cancelation fee.

    We appreciate your understanding and look forward to supporting your unique health and wellness needs and goals. 
     
  • Should be Empty: