Name*
First Last
Email
Phone*
(###)###-####
In-Person or Online TeleHealth Appointment?*
- In-Person
- Online Telehealth
Please note - Online TeleHealth is available for Physiotherapy & Chiropractic appointments ONLY and requires the use of technology (NOT compatible with the Safari browser).
Returning or New Client?*
- Returning
- New
Preferred clinic for future appointments?*
- Currie Center
- Prospect Street
- Either
Service*
Additional Information*
Please provide details regarding your injury/condition.