Consent to Treat

I consent to be assessed and treated by a Registered Massage Therapist. Because Massage is contraindicated under certain conditions, I affirm that I have stated all my known medical conditions and answered questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I forget to do so.

Consent for Personal Information

I understand that in order to provide safe treatment my healthcare practitioner may need to communicate with my physician regarding my condition and treatment. I understand that Cardio-Go may need to communicate as applicable, with my lawyer, the WSIB, my employer or auto insurance company to send or receive information pertaining to my treatment. I also understand that my personal information will solely be used to the extent necessary for the goods and services provided by Cardio-Go and will not be shared with any other party without my consent.

Payment Policies

Payment is due at the end of every treatment session by cash, debit, Visa or MasterCard with the exception of WSIB & Auto Insurance claims. You will be provided with a receipt that you can submit to your insurance provider for reimbursement.
As the policy holder, it is your responsibility to contact you insurance company and confirm the exact details of your coverage.
Most insurance companies require you to pay upfront for Orthotic devices & braces. You will be provided with a receipt that you can submit to your insurance provider for reimbursement.

CANCELLATION & NO-SHOW POLICY

Cardio-Go strives to provide exceptional care to our clients. We aim to provide care that best meets your needs and schedules. However, missed clinic appointments and frequent cancellations do impact our ability to provide quality services.
In order to respect the time of our clinicians and to offer fair availability to all of our patients, we kindly
ask for 24 hours notice to cancel a clinic appointment. In the absence of 24 hours notice or in the case of a no-show, the full fee for the scheduled service will be applied to your account. This fee must be paid in full before or at the time of your next appointment. We are not able to bill insurance plans for missed or no-show appointments.

LATE PATIENT POLICY

At Cardio-Go, our goal is to make every clinic visit efficient, enjoyable, and stress-free. Late clients impact the quality of care by reducing patient time with the clinician. If you are late, we will make every effort to see you for the remainder of the scheduled time. The full fee for the scheduled service will be charged for this appointment.
By signing below, you accept the terms of our cancellation, no show, and late patient policies and agree to pay any charges to your account that may result.

Privacy of personal information is an important principle at Cardio-Go. We are committed to collecting, using and disclosing personal information responsibly and only to the extent necessary for the good and services we provide. We also try to be as open and transparent as to how we handle personal information.
If you have any questions, please ask the Front Desk staff or the Health Care Practitioners.

• We are able to bill some (not all) insurance companies directly for your Physiotherapy, Massage Therapy, Chiropractic and Acupuncture treatments.
• As the policy holder, it is your responsibility to contact your insurance company and confirm the exact details of your coverage including requirement for physician requisitions. Our front desk staff would be happy to assist you with any questions regarding your insurance coverage for our services.
• You may be required to pay a deductible or make a co-payment if your insurance plan defines so. Deductibles & co-payments are due at the end of your visit. Any unpaid balances will be charged to your credit card on file.
• We are only able to direct bill to your primary insurance plan. We are not able to do any co-ordination of benefits to secondary plans (spouse or other parent's plans).
• If you have been involved in a motor vehicle accident & have extended health insurance, your auto insurer requires your treatments to be billed to the extended health plan first. Please provide primary & secondary (if applicable) insurance information below:

By signing this Digital Signature a capture of your IP address and location will be submitted to Cardio-Go confirming your consent.