• Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Examples: Referred by a doctor, referred by friend/colleague/family, advertising (brochures, banner, etc.), by chance/walk in, by employee staff, internet search, returning patient
  • Consent for Physiotherapy

  • Physiotherapy Consent
    Please input your FULL NAME here!
  • Confidential Health History Form

  • Visual Analog Scale

  • Referring to the drawings below, please indicate where you are experiencing pain by describing the area of injury, and the scale number for your current level of pain. Please list where you are feeling the pain (I.E. neck, back, shoulder, etc.) .

  • Please refer to above picture for the answer to this question.
  • Please refer to above picture for the answer to this question.
  • Please refer to above picture for the answer to this question.
  • WSIB Information Sheet

  • Date Format: MM slash DD slash YYYY
  • Employer Information

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