Patient Forms

We offer our paperwork online so you can complete it in the convenience of your own home or office. We understand that you are busy, so here are the essential forms we use. If this is your first time at the clinic, please complete all relevant forms to your visit.

New Patients

pdf_file.gif  Initial Intake Form

Informed Consent

pdf_file.gif  Consent Chiropractic

pdf_file.gif  Consent Physiotherapy

pdf_file.gif  Consent Acupuncture

pdf_file.gif  Consent Massage

pdf_file.gif  Consent Orthotic

Additional Forms (if these apply)

pdf_file.gif Car Accident Form

pdf_file.gif  Custom Orthotics

pdf_file.gif  Fantastic Lifestyle


 Food Journal






Office Policies (please read)

pdf_file.gif Office Fees

pdf_file.gif Missed / Late Fees


 Privacy Policy

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Streetsville Acupuncture - Mississauga

Port Credit Acupuncture - Mississauga