Client Forms
Please choose the applicable client form below. Once you click on the link, it will open in a new window and you will be able to print out and complete the forms included.
As well, please note that if you are under 18 years of age, you will need a parent or legal guardian to fill out the forms on your behalf before attending the initial appointment.
If you have any questions in regards to the forms, please contact the clinics at 780-458-8505 (St. Albert Physical Therapy), 780-458-8502 (Dynamic Sports Physiotherapy), or 780-452-8234 (Kensington Physical Therapy).
Initial Physiotherapy Assessment
Motor Vehicle Accidents
Alberta Accidents Benefits Initial Claim Process (AB-1)
Diagnostic and Treatment Protocols Authorization
Extended Health Care Forms
* Please note that some extended health care companies may require a medical referral or physician prescription (which is dependant . If you ever unsure if this is required, it is always best to contact your extended health care company. Contact numbers for each of the companies we direct bill to are included below.
ASEBP (Alberta School Employee Benefit Plan)
General Inquiries – 780-438-5300
Great West Life & Send Payment Great West Life Form (has the cheque issued from GWL sent directly to our office)
General Inquiries – 1-800-957-9777
Greenshield
General Inquiries (head office) – 1-519-739-1133
Blue Cross (requires no form on file for direct bill, please bring in a copy of your valid Blue Cross card as we are able to offer online direct billing if claims are submitted within 30 days). As of December 1, 2011, we are now able to direct bill to Alberta Blue Cross for massage therapy (should your plan include this service).
General Inquiries – 780-498-8000
Dietary Assessment