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Fraser Health Concussion Clinic #104 218 Blue Mountain Street Coquitlam, BC V3K 4H2 pH: 6045285387 FX: 6049360955CONCUSSION CLINIC (EARLY INTERVENTION FORM TBI) REFERRAL FORM CLIENT INFORMATION: NAME:
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How to fill out fraser health concussion clinic
How to fill out fraser health concussion clinic
01
To fill out the Fraser Health Concussion Clinic form, follow these steps:
02
Download the form from the Fraser Health website or obtain a physical copy from the clinic.
03
Fill in your personal information, including your full name, date of birth, address, and contact details.
04
Provide details about your concussion, including the date of the injury, how it occurred, and any symptoms you are experiencing.
05
Answer questions about your medical history, including any previous concussions or head injuries.
06
Include information about any current medications you are taking.
07
If applicable, provide information about any ongoing treatment or therapies you are receiving for your concussion.
08
Sign and date the form.
09
Submit the completed form to the Fraser Health Concussion Clinic either in person or by mail, as instructed on the form or by the clinic staff.
Who needs fraser health concussion clinic?
01
Fraser Health Concussion Clinic is designed for individuals who have experienced a concussion and require specialized medical care and treatment.
02
This clinic caters to people of all ages, including children, adolescents, and adults.
03
Anyone who has suffered a concussion, whether sports-related, due to an accident, or any other cause, can benefit from the services provided by the Fraser Health Concussion Clinic.
04
This clinic is particularly helpful for individuals experiencing persistent symptoms, such as headaches, dizziness, memory problems, and cognitive difficulties, following a concussion.
05
It is important to consult with healthcare professionals at the clinic to receive proper assessment, diagnosis, and treatment for concussion-related issues.
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What is fraser health concussion clinic?
The Fraser Health Concussion Clinic is a specialized clinic that provides assessment and treatment for individuals who have experienced a concussion.
Who is required to file fraser health concussion clinic?
Patients who have experienced a concussion and are seeking medical assessment and treatment are required to file with the Fraser Health Concussion Clinic.
How to fill out fraser health concussion clinic?
To fill out the Fraser Health Concussion Clinic, patients must schedule an appointment with a healthcare provider at the clinic and provide information about their concussion symptoms and medical history.
What is the purpose of fraser health concussion clinic?
The purpose of the Fraser Health Concussion Clinic is to provide specialized care for individuals who have experienced concussions, helping them to recover and manage their symptoms.
What information must be reported on fraser health concussion clinic?
Patients must report information about their concussion symptoms, medical history, and any previous treatments or interventions they have received.
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