Contact Us

Our Location

266 Harold Dent Trl, Oakville, ON L6M 1S1

Phone Number

+1 (647) 831-7775

Working Hours

Monday - Friday 10:00 A.M. - 06:30 P.M.
Saturday 10:00 A.M. - 4:00 P.M.
Sunday CLOSED

Email Us

physio.globalhealth@gmail.com

General Intake Form

Name

DOB

Age

Gender

Phone no

Who has referred you to our clinic?

Emergency contact name

Emergency Phone

Family Physician

Family Physician Phone

Employment data:

Occupation

Extended Heath Care data: Primary insurance

Policy#

ID/Cert#

Secondary insurance

Policy#

ID/Cert#

Auto Insurance Data (MVA Patients ONLY)

Insurance company Policy#

Date of Accident

Claim#

Adjuster's Name:

Adjuster's Phone

WSIB Information:

Date of Injury

Adjuster's Name

Adjuster's Phone

Insurance & Proof of address

Health Card #

Name

DOB

Age

Gender

Phone no

Who has referred you to our clinic?

Emergency contact name

Emergency Phone

Family Physician

Family Physician Phone

Employment data:

Occupation

Extended Heath Care data: Primary insurance

Policy#

ID/Cert#

Secondary insurance

Policy#

ID/Cert#

Auto Insurance Data (MVA Patients ONLY)

Insurance company Policy#

Date of Accident

Claim#

Adjuster's Name:

Adjuster's Phone

WSIB Information:

Date of Injury

Adjuster's Name

Adjuster's Phone

Insurance & Proof of address

Health Card #

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Contact Us

Our Location

Phone Number

Working Hours

Email Us

General Intake Form

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