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New Patients
Please click female or
male to download a health
intake form. Please fill out in advance and bring with you
to your appointment. Completing this form in advance
streamlines your assessment and ensures time for initial
treatment. Thank you!
* please note, if this is an auto insurance or WSIB (Worker's
Compensation) claim, please contact us for the proper forms to
be completed. *
Notice of 24 hours to reschedule or cancel
an Appointment
for Therapy
When we reserve an
appointment for you, there are three people involved: you, the
therapist, and another patient waiting for an open appointment. We
require 24 hours notice should you need to reschedule or cancel your
appointment, otherwise a missed appointment fee of $45 will be billed.
Privacy Policy
On
November 1st, 2004 the Personal Health Information Protection
Act (PHIPA) came into effect. The act creates rules for the collection,
use and disclosure of personal health information by health care
providers, and is a sub-act related to the Personal Information Privacy
and Electronic Documents Act (PIPEDA). It also outlines your right to
access your records, to correct inaccurate information, and to determine
how your personal information can be used.
As
regulated health professionals, massage therapists already adhere to
high standards in the protection of your personal information,
including:
·
health history,
general health status and particulars around health conditions and
medications
·
contact
information (name, address, date of birth, telephone number, email
address)
·
name and
address of primary care provider/physician.
This
information is kept in a file cabinet that is lockable, and away from
public access. Only Therapeutics associates can access your file. We
also keep financial records of payment for services rendered, and
assessment/treatment notes. We retain this information for 10 years
following your last recent treatment, at which time it is shredded and
destroyed. Electronic documents are password-protected.
We will disclose this
information only when required by law, or with your written permission.
Express (written)
consent is required to share information outside of your circle of
care. Verbal consent is adequate to contact other health care providers
within this circle. You have the right to alter or withdraw your
consent at any time.
We also collect
information on your occupation, birth date, and availability of extended
health plans for statistical purposes. As well, we utilize contact
information to mail or email a clinic newsletter. You can withdraw
consent to receive such information by contacting
relief@dondillon.ca
or, for new patients, check-marking the box on the intake form
indicating you would prefer not to receive our mailings.
Should
you wish to view your records, express a concern, or withdraw consent on
how your information is used, please contact our Privacy Officer –
Donald Dillon, RMT at 19 Durham Drive, St. Catharines ON, L2M 1C1
(
905 937 5802. Please do not hesitate to contact us with any questions
or concerns. As always, we respect and protect your personal
information. Thank you!
To
contact the Privacy Commissioner, call 1 800 461 2036 or visit
www.health.gov.on.ca
Complaints
Policy
If you
wish to file a concern regarding your care, please talk to your
therapist directly and try to resolve your concerns. If you do not find
satisfaction in this process, please discuss the matter with
Therapeutics Clinical Director Donald Quinn Dillon, RMT. You can reach
him at relief@dondillon.ca or call 905 937
5802.
If your complaint
is not resolved to your satisfaction,
you can contact the College
of Massage Therapists of Ontario at
www.CMTO or call 416 489 2626. Address - 1867 Yonge Street, suite
810, Toronto, ON M4S 1Y5
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