2021 Russett Rehabilitation Patient Forms
Our forms relating to your treatment and linked insurance claims. Just click to view and/or download.
Patient Intake Forms
Please select the relevant service below to view the correct patient intake forms.
Please ensure you complete all 4 forms in this section and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
Please ensure you complete all 5 forms in this section as a Concussion Patient and submit them back to us.
Concussion Intake
New Patient
Health History
Privacy Policy
Payment Policy
Please ensure you complete all 5 forms in this section as a Vestibular Patient and submit them back to us.
Vestibular Intake – Vertigo
New Patient
Health History
Privacy Policy
Payment Policy
Please ensure you complete all 6 forms in this section as a Physiotherapy Patient and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
OHIP Consent
OHIP Compliance
Please ensure you complete all 4 forms in this section as a WSIB Patient and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
Please ensure you complete all 5 forms in this section as a New Chiropractic Patient and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
Chiropractic Consent
Please ensure you complete all 5 forms in this section as an Acupuncture Patient and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
Acupuncture Consent
Please ensure you complete all 5 forms in this section as a Massage TherapymPatient and submit them back to us.
Patient Intake
Health History
Privacy Policy
Payment Policy
Massage Consent
Please ensure you complete the form in this section as an Orthotics Patient and submit it back to us.
Orthotic Intake
Roland Morris – BACK
LEFS – LOWER EXTREMITY
NDI – NECK
QUICK DASH – UPPER EXTREMITIES
Quick Dash Work Module – UPPER EXTREMITIES
WSIB Concussion Rivermead
OHIP Information
More information: https://www.ontario.ca/page/physiotherapy-clinics-ohip-funded
WSIB Information
More information: https://www.wsib.ca/en