Get the free CONCUSSION CLINIC REFERRAL FORM 399 Bathurst St., 5WW - UHN
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399 Bathurst St., 5WW Toronto, ON. M5T 2S8 Phone: 4166035232 Fax: 4166036402CONCUSSION CLINIC REFERRAL Commonly patients with concussion/mild traumatic brain injury are seen in this clinic. We do
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How to fill out concussion clinic referral form
How to fill out concussion clinic referral form
01
Obtain a concussion clinic referral form from your healthcare provider.
02
Fill out your personal information including name, date of birth, address, and contact information.
03
Provide details about your concussion including date of injury, symptoms experienced, and any previous treatment received.
04
Sign and date the form to confirm that the information provided is accurate.
05
Submit the completed form to the concussion clinic for review and scheduling of an appointment.
Who needs concussion clinic referral form?
01
Individuals who have experienced a concussion and require specialized care and treatment.
02
Athletes who have sustained a head injury while participating in sports.
03
Individuals who have been involved in an accident or fall that resulted in a head injury.
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What is concussion clinic referral form?
The concussion clinic referral form is a document used to refer a patient to a specialized clinic for the diagnosis and treatment of concussions.
Who is required to file concussion clinic referral form?
Medical professionals, such as physicians or athletic trainers, are required to file the concussion clinic referral form.
How to fill out concussion clinic referral form?
The concussion clinic referral form can be filled out by providing the patient's information, details of the injury, and any relevant medical history.
What is the purpose of concussion clinic referral form?
The purpose of the concussion clinic referral form is to ensure that patients receive appropriate care and treatment for their concussions.
What information must be reported on concussion clinic referral form?
The concussion clinic referral form must include the patient's name, contact information, details of the injury, and any relevant medical history.
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