Forms

Physiotherapy Visits:

Work Related Injuries (WCB)

• Patient Intake Form
• WCB Intake Form
• Medical Authorization Permission Form
• COVID-19 Questionnaire

Motor Vehicle Injuries (Auto Insurance)

• Patient Intake Form
• AB 1 form
• Medical Authorization Permission Form
• COVID-19 Questionnaire

Private Insurance (EHB): Alberta Blue Cross, Greenshield, Great West Life, & etc…

• Patient Intake Form
• Direct E-Claim Authorization Form
• Medical Authorization Permission Form
• COVID-19 Questionnaire

Self-Pay Clients

• Patient Intake Form
• Medical Authorization Permission Form
• COVID-19 Questionnaire

Massage Visits: (MVA, EHB, Self-Pay)

• Massage intake Form
• Medical Authorization Permission Form
• COVID-19 Questionnaire

Custom-made Orthotics:

• Orthotics Checklist