2021 Russett Rehabilitation Patient Forms

Patient Intake Forms

Please ensure you complete all 4 forms in this section and submit them back to us.

PHYSIOTHERAPY

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

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CONCUSSION PATIENT

Please ensure you complete all 5 forms in this section as a Concussion Patient and submit them back to us.

Concussion Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=4647f480-1172-480b-b433-56604723dcae&DomainID=631b6f44-94e5-471d-9c0e-8363a9bce76d

New Patient

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

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VESTIBULAR PATIENT

Please ensure you complete all 5 forms in this section as a Vestibular Patient and submit them back to us.

Vestibular Intake – Vertigo

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=27c70848-24c6-4990-964d-df44a4898a71&DomainID=631b6f44-94e5-471d-9c0e-8363a9bce76d

New Patient

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

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OHIP PHYSIOTHERAPY PATIENT

Please ensure you complete all 6 forms in this section as a Physiotherapy Patient and submit them back to us.

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

OHIP Consent

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=d104fe81-bc52-4270-96d1-675d0627f825&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

OHIP Compliance

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=e1c8aa8c-55f4-4e80-abe1-d6b15e9b517b&DomainID=631b6f44-94e5-471d-9c0e-8363a9bce76d

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WSIB PATIENT

Please ensure you complete all 4 forms in this section as a WSIB Patient and submit them back to us.

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

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CHIROPRACTIC PATIENT

Please ensure you complete all 5 forms in this section as a New Chiropractic Patient and submit them back to us.

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Chiropractic Consent

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=f9680f88-7462-4995-8d21-01698e0bfc7a&DomainID=bf716564-2485-4bd5-97e2-84c52427307b

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ACUPUNCTURE  PATIENT

Please ensure you complete all 5 forms in this section as an Acupuncture Patient and submit them back to us.

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Acupuncture Consent

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=cbe4e33e-57e8-4c9e-b1b6-929a030847d2&DomainID=bf716564-2485-4bd5-97e2-84c52427307b

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MASSAGE THERAPY (RMT) PATIENT

Please ensure you complete all 5 forms in this section as a Massage TherapymPatient and submit them back to us.

Patient Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c7c52b35-2939-410c-848a-f80c1a922506&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Health History

https://www.reachlite.com/portal/EFormUpdate.aspx?usid=29e54dd9-c70c-4d81-b71b-4ea57408e8b0&eFormId=0f9bc780-6e9f-4857-a8d7-b31f4cab2953&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Privacy Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=40c1213b-af6b-4bc0-ad8b-e632c9425863&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Payment Policy

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=5a61ae69-5e64-4592-b637-48e3a8880eff&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Massage Consent

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=d222c591-ffd0-466c-a898-c88cac297a6b&DomainID=bf716564-2485-4bd5-97e2-84c52427307b

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ORTHOTICS PATIENT

Please ensure you complete the form in this section as an Orthotics Patient and submit it back to us.

Orthotic Intake

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=80cb9986-4c0c-4df5-bd19-35ff4fa6de65&DomainID=bf716564-2485-4bd5-97e2-84c52427307b

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OUTCOME MEASURES

Roland Morris – BACK

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=2ccb14a7-44fe-414d-90ae-62f63283fb2f&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

LEFS – LOWER EXTREMITY

 https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c0b0ef7a-f01d-4410-9920-b62300f16951&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

NDI – NECK

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=8a9d6235-4dfb-4695-9b74-c8b77d968520&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

QUICK DASH – UPPER EXTREMITIES

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=0552b9ab-35cb-41a7-9ac9-714cbe4a71ae&DomainID=8ddf15d6-ff41-4bf9-825b-0ae3c29fb30b

Quick Dash Work Module – UPPER EXTREMITIES

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=c2b6e3cc-189c-47f2-a719-672fd78fc561&DomainID=631b6f44-94e5-471d-9c0e-8363a9bce76d

WSIB Concussion Rivermead

https://www.reachlite.com/portal/EFormUpdate.aspx?eFormId=2c19489c-f4a1-4d60-b0ba-cff930350c4d&DomainID=631b6f44-94e5-471d-9c0e-8363a9bce76d

OHIP Information

More information: https://www.ontario.ca/page/physiotherapy-clinics-ohip-funded

WSIB Information

More information: https://www.wsib.ca/en