We are located at

162 Metcalfe street
Ottawa, Ontario
K2P 1P2

Phone number

(613) 851-0261

Email

info@elanvital.ca

annie@elanvital.ca

danielle@elanvital.ca

Hours

Monday 10:00am-7:00pm

Tuesday 10:00am-7:00pm

Wednesday 10:00am-7:00pm

Thursday 10:00am-7:00pm

                                                                                 Friday 9:00am-7:00pm

                                                                                Saturday 10:00am-4:00pm

 

Health History Form *
Health History Form
The information request below will assist us in treating you safely. Feel free to ask any questions about the information being requested. Please note that all information provided below will be kept confidentially unless allowed or required by law. Your written permission will be required to release any information.
Phone
Phone
Address
Address
Have you received massage therapy before?
Have you received massage therapy before?
Did a health care practitioner refer you for massage therapy?
Please indicate conditions you are experiencing or have experienced:
Cardiovascular
is there a family history of any of the above?
Infections
Other Conditions
Please provide details about your condition
Head/Neck
Women
Overall, how is your general health?
Primary Care Physician:
condition it treats
Are you currently receiving treatment from another health care professional?
Surgery date and nature
Do you have any other medical conditions?
Do you have any internal pins, wires, artificial joints or special equipment?
What is the reason you are seeking massage therapy or osteopathy?