Forms

Physiotherapy Visits

Work Related Injuries (WCB)

• Physiotherapy Intake Form
• Physiotherapy Assessment Form
• WCB Intake Form
• Release & Request of Medical Records authorization

Motor Vehicle Injuries (Auto Insurance)

• Physiotherapy Intake Form
• Physiotherapy Assessment Form
• AB 1 Form
• Release & Request of Medical Records authorization

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

• Physiotherapy Intake Form
• Physiotherapy Assessment Form
• Direct E-CLAIM Submission Authorization Form
• Release & Request of Medical Records authorization

Self-Pay Clients

• Physiotherapy Intake Form
• Physiotherapy Assessment Form
• Release & Request of Medical Records authorization

Please complete according to the location of your injury(s)

• Roland Morris Back Questionnaire
• Upper Extremity Fuctional Index
• Lower Extremity Fuctional Index
• Neck Disability Index

Chiropractic Visits

• Intake Form
• Chiro Package Forms

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

• Massage Intake Form
• Release & Request of Medical Records authorization

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