Appointment Request for Physiotherapy
Step 1 of 6
1. Let's start by getting to know you a little better.
Date of Birth (DD/MM/YYYY):
Date Format: DD slash MM slash YYYY
2. Are you looking to be treated because of an injury?
Do you have an injury?
If yes, please give us a bit more information on your injury.
3. Is your pain chronic?
4. Do you need treatment following a car accident or an accident in the workplace?
Please note, we do not treat any injuries pertaining to car accidents involving the SAAQ or workplace accidents involving the CNESST.
5. When are you available for an appointment?
Potential Appointment Date (DD/MM/YYYY):
Date Format: DD dash MM dash YYYY
8. How can we reach you?