(416) 554-3830info@dcrmt.com438 University Ave Suite 104

Forms

Please complete the Health History Online Form below prior to your first appointment.

Forms are also available for download. You can email the forms here prior to your appointment or print out hard copies, fill them out and bring them with you to your first appointment.

For information on direct billing to your private insurance, please review this post.

Download Forms

Health History

Health History Online Form

Please indicate conditions you are experiencing or have experienced.
Please indicate conditions you are experiencing or have experienced.
Please indicate conditions you are experiencing or have experienced.
Please indicate conditions you are experiencing or have experienced.
Eg: type of reaction?
Please indicate conditions you are experiencing or have experienced.
Please indicate conditions you are experiencing or have experienced.
Eg: digestive condition, haemophilia, osteoporosis, mental illness
Eg: digestive condition, haemophilia, osteoporosis, mental illness
Please include the location of any tissue or joint discomfort
I am providing my consent to receive Registered Massage Therapy treatment(s) from Droughan Costello Registered Massage Therapy. I understand that treatments may include assessment of my soft tissue and joints, stretching or strengthening exercises as indicated by my condition. I understand that my therapist will discuss the treatment plan with me to ensure that I receive a safe and effective treatment. I know it is my right to discuss any component of my treatment with the therapist and that my consent can be rescinded at any time.
To avoid charges, I request a minimum of 24 hours notice for cancellation. A 100% cancellation fee may be charged if you do not show up for your appointment. This is done in fairness both to clients who would otherwise have wanted the appointment and to the therapist, who is not paid if they do not perform the session. As a courtesy to everyone, I thank you for being prompt. Late arrivals can only be extended to the time remaining in the scheduled session. I have read and understood the informed consent, cancellation and late arrival policy.