So you want to be an ACTIVE THERAPY patient with Better Call Doc?
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Great! We want to help you.
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This form is for you if you are skipping with any pain therapy altogether & are moving straight to active therapy rehabilitation.
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You feel you are ready to use exercise &
movement therapy to help manage your condition.
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Let's start with your medical history,
then you will consult directly with Dr. Rice.
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IT TAKES APPROXIMATELY 6 MINUTES TO COMPLETE THIS SECTION
TO REQUEST A MEDICAL HISTORY BY TELEPHONE PLEASE CALL OR EMAIL YOUR REQUEST:
IF YOU PREFER TO FILL IN A PAPER FORM WE CAN DO THIS AT THE CLINIC OR WE CAN SEND YOU A FORM YOU CAN PRINT TO FILL-OUT.
ALTHOUGH WE ARE A PAPERLESS CLINIC WE WILL WILL SCAN YOUR DOCUMENT & SECURELY KEEP THEM IN OUR SECURE PATIENT SERVER.
ATTENTION
THIS FORM DOES NOT SAVE A YOU COMPLETE IT.
PLEASE BE PREPARED TO FINISH COMPLETING IT IN ITS ENTIRETY & THEN MAKE SURE YOU PRESS SEND.
I understand that Dr. Michel Rice is formally my doctor of chiropractic who I am consulting with on the personal medical subject matter described in this form.
I understand that Dr. Michel Rice clinically directs the active therapy program.
Dr. Rice works with my fitness practitioner for both program supervision and clinical re-evaluations. Fees for medical review + initial consult [$122] & re-evaluations [$62] apply.
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The clinic does NOT extend direct insurance billing. Rather, once a receipt is provided the patient (you) may submit a receipt for direct payment from the insurer using a DC licence 2225 [doctor of chiropractic - Province of Ontario]
