Health History Form

Before your first visit, we ask that you take a few minutes to complete our Health History Form. It allows us to design a safe and effective treatment for you, working toward your health goals. As our privacy policy explains, we will not release any of this information without your consent except as required by law. If any of your health or contact information changes in the future, please let us know so that we can continue to work together safely and effectively.

Download the Health History Form

Body Poets Privacy Policy

We take your privacy seriously. Your health history and treatment notes are your personal property, and are confidential between you and your registered massage therapists.

We will only share your personal and health information:

  • When you ask us to do so
  • To get advice on your care, without revealing your identity
  • When required by a third-party payer (e.g. insurance company)
  • As required by law

We collect your personal and health information in order to:

  • To treat and care for you
  • To contact you about appointments or treatment options
  • To consult with supervisors about your care (without revealing your identity)
  • To plan and administer internal operationsTo consult with supervisors about your care (without revealing your identity)
  • To verify or receive payment for your care from a third-party payer (e.g. insurance company)
  • To comply with legal and regulatory requirements

If we need your information for some other purpose not listed here, we will notify you and get your permission to use it.

How we protect your personal information

  • We only collect data needed to treat you effectively
  • We make sure your information is up to date
  • We keep your information private and under lock and key
  • You have access to your health records at any time
  • You may make corrections to your health records at any time
  • You may get a copy of your file, with a small copy fee
  • We get your permission to share your health records with other health care providers
  • We keep your health records for 10 years from your last visit, and then destroy them securely

If you have questions or complaints, please speak to Ellen Symons, RMT at or 613-222-0465.

If your concern is not resolved, you can contact the Information and Privacy Commissioner of Ontario at 1-800-387-0073.