This is a confidential intake form for what we call a preliminary screening.
We are screening you to see if you suffered a serious spinal injury as the result of your motor vehicle accident.
If the doctor thinks you may have a ligament instability in your neck or lower back, we will proceed with a screening examination followed by a specialty x-ray.
IT TAKES APPROXIMATELY 10 MINUTES TO COMPLETE THIS FORM
Confidential Screening Examination
Specialty End-Range Stress Test X-ray Screen
In collaboration with the Ontario Research Medical Group,
a sub-division of Better Call Doc Inc.
S C R E E N I N G Q U E S T I O N S P E R T A I N I N G T O Y O U R A C C I D E N T
Thanks for submitting. The doctor will review your records. Your medical information complies with the provincial information privacy act (HIPPA)