BONAVISTA PHYSICAL THERAPY  |  739 Lake Bonavista Dr. SE, Calgary  |  Lower Level of Bonavista Medical Clinic

WCB Intake Form

Male Female 
Gender *


Employer Information


Medical Information


Physiotherapists practice within a code of ethics, and a privacy policy is in place.

  • In case of an emergency in this office, your therapist or another staff member will inform you of evacuation procedures.
  • I understand that I am able to decline treatment at any time.
  • I am aware that there is a grievance procedure and that I can appeal decisions regarding my care in case I am not satisfied with the service.
  • I will allow Bonavista Physical Therapy Clinic to communicate with my physician, my radiologist, the Worker’s Compensation Board and my employer regarding my condition.
  • I understand that if Worker’s Compensation Board does not accept responsibility for the claim, I will be responsible for the cost of treatment.
  • I have provided a VISA or MC draft as insurance in the case my claim is not accepted.

  I acknowledge and understand the above information

 

HUNDREDS OF SATISFIED PATIENTS

Greg McFetridge
Thank you for getting Maureen and I started. Very happy with the service. It enabled us both to be able to transition to other physical...
thanks for these great reviews!
Pavithra Raman 6 months ago Recently had a massage sessions with Erin and Sharon. They did a very good job. Worth every penny spent...
Judith Attwell
I have been attending Bonavista for the past five weeks. I am extremely satisfied with the progress I am making for a torn meniscus. I ...
Read More