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Massage Patient History Form

Please indicate if you believe if any of the following apply to you?

Other therapy / treatment: (past or present, does not have to be related to this visit)

Please SELECT the answer closest to how you PRESENTLY feel:


Current Condition

Please Note: Your appointment time has been reserved for you. . In courtesy of your therapist

I authorize the clinic and its associated RMTs to collect my personal and medical information as documented above in order to contact me, and give permission for the clinic to leave messages regarding appointments at any of the contact numbers I have provided above. In addition, I authorize the clinic and its associated RMTs to communicate with my referring MD as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.

Exclusive Offer


Ultralignment G2 by SIGMA Instruments

Ask about Shockwave Therapy Special Pricing. 

THIS ---->https://atlaschiropracticca.chiromatrixbase.com/new-patient-center/new-patient-health-history-form.html

Office Hours

Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
12pm 9am 12pm 9am 9am 9am Closed
6pm 6pm 6pm 6pm 2pm 2pm*

*Saturdays hours, once a month, please call our office 250.585.6325 for the schedule


Our Clients Say it Best 

 I am very pleased with the results I am experiencing following my visits to see Dr. Barry Whyte. After suffering from a broken fibula 7 years ago, I am finally feeling some relief from the foot pain that never ever seemed to go away. Finally a window of opportunity has opened and I can begin to get my life and the lifestyle back on track. The biggest THANK YOU to Barry and his staff.

Leo Vallee

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