1300 Don Mills Rd. Unit 104
North York, ON M3B 2W6



Health History Forms

Please fill out our Health History Form below before your first visit.

chiropractic health form acupuncture health form

We are required by health care law to obtain a complete health history from our patients before we can provide treatment. Any health information you share with us is always 100% confidential.

We use a health care clinic management system which stores our information digitally, and securely. The system itself is also owned by health care providers, who are bound by the same confidentiality laws that we are. The system uses commercially standard means of protecting your information, including intrusion and anti-malware monitoring, encryption, and SSL protocols. Our health history form is protected by these same standards.

Your information is not shared with any third party without your explicit consent (except whereas required by law). Situations where we may seek out your consent to share information include insurance reimbursement claims, consultations with other health care providers you have seen, and other similar scenarios concerning the provision of care. In those situations, we will require your permission before releasing any information.

Acupuncture Health History Form
Download this patient information form, fill it in and bring it to our office.

Adobe Reader is needed to open this form. If you do not have Adobe Reader, please download the free application here.