Appointment Request

Appointment Request

Required Field

*All initial appointments are 1 hour. The cost for our 1 hour treatments is $206.79, including HST.

**If there is an issue with submitting this form, please email us directly at admin@ventepainrelief.com or phone us at 416-644-8894.

Personal Info

First Name

Last Name

Contact Info

Email

Phone number

What is the best phone number to contact you?

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How did you hear about us?

We would love to hear how you heard about us.

Are you a new patient?

Please check.

I have been referred by a Vente patient (we will contact you for verification)

I have completed the Self-assessment survey

I have a signed Vente Therapy Recommendation form

I am a current Vente patient

Length of time you've had your condition

Have you had this issue for a long period?

About your condition

Please describe your condition.

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Types of therapies

Have you tried any of these therapies? (Please check all that apply)

Physiotherapy

Massage Therapy

Chiropractic

Acupuncture

Other

Combination of therapies

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