Address:1278 Shillington Ave., Ottawa, ON, K1Z 8A4
Tel: 613-710-9555
Section 1: Patient Information
Section 2: Past Medical History & Ongoing Health Conditions
Section 3: Consent to Treatment: Click Here to read the consent. Question Contact (613-710-9555/ clinic1278@gmail.com)
I have read the full consent from the link above. I (or the substitute decision-maker listed below) consent to have my practitioner to perform the following treatment on me: Acupuncture, Cupping, Scraping, Moxibustion, Chinese Herb, Acupressure/Tuina Massage, Chinese Medicine Dietary and Exercise.*
Section 4: Consent to Collect, Use and Disclose Personal Health Information: Click Here to read the consent. Question Contact (613-710-9555/ clinic1278@gmail.com)