Looking for the Best Physical Rehab?

Call : +1 (416) 249-8668

Email : info@trinityrehab.ca

About Us
- Who We Are
- Our Team
- Careers
- Gallery
Services
- Core Services
- What We Treat
Patient Center
Contact Us
Blogs

Looking for the Best Physical Rehab?

Call : +1 (416) 249-8668

Email :info@trinityrehab.ca

Facebook Instagram Youtube Linkedin

About Us
Our Services
Patient Center
- Forms
Contact Us
FAQ

About Us
- Who We Are
- Our Team
- Careers
- Gallery
Services
- Core Services
- What We Treat
Patient Center
Contact Us
Blogs

Looking for the Best Physical Rehab?

About Us
Our Services
Patient Center
- Forms
Contact Us
FAQ

About Us
Our Services
Patient Center
- Forms
Contact Us
FAQ

Thank you for connecting with us. We will respond to you shortly.

1

1

https://trinityrehab.ca/wp-content/plugins/nex-forms

false

message

https://trinityrehab.ca/wp-admin/admin-ajax.php

https://trinityrehab.ca/accidentprofile-form

yes

1

fadeIn

fadeOut

TPh. 416-249-8668, Fax. 416-249-5794, Email:info@trinityrehab.ca
1 723 Kipling Ave. Unit#9, Etobicoke, ON M9R4E1
www.Trinityrehab.ca

ACCIDENT PROFILE

Patient’s Name:

Date of loss:

Were you working at the time of the accident?

Yes

No

Type of vehicle:

Time of accident:

Amount of Damage:

Location of Accident:

How did the accident happen?

Were you wearing your seatbelt? Helmet if on bike or motorcycle?

Yes

No

Did you hit your head? If yes, where?

Yes

No

Where:

Were you able to exit the vehicle independently? If no, how did you exit?

Yes

No

how did you exit?

Did the ambulance arrive?

Yes

No

If yes, were you transported to hospital?

Did the airbags deploy?

Yes

No

Did you hit any other part of your body inside the vehicle? If yes, where?

Yes

No

Where:

Were you bleeding?

Yes

No

Did the police arrive?

Yes

No

Were you?

Drving

Passenger

Did you lose consciousness? If yes, how long?

Yes

No

How long?:

Any nausea or vomiting after accident?

Yes

No

Was an accident report filed?

Yes

No

TREATMENT RECEIVED

DID YOU VISIT THE FOLLOWING?Please Select Both Checkbox.

Hospital

Family Physician

HOSPITAL

Date:

Name of Doctor:

Other:

Name / Location:

Findings:

Name of Doctor:

Prescribed Medications:

Family Physician

Date:

Name of Doctor:

Other:

Name / Location:

Findings:

Name of Doctor:

Prescribed Medications:

Have you received treatment at any other therapy clinic for this accident?

Yes

No

End Date:

Did you feel better after the treatment already received?:

*Name of the Clinic:

Frequency:times / week

Translation needed:

Yes

No

Start Date:

Type of therapy:

Chiropractic

Physiotherapy

Massage

Exercises

Comments:

I hereby certify that I have read and understand the information recorded and verify that it is true and accurate.

Patient’s Signature:

Request an Appointment

Facebook Instagram Linkedin Youtube

Faq's
Privacy Policy
Copyright ©Trinityrehab&wellness. All Rights Reserved.

9806071234

sendmail@example.com

Contact

Service

Denounce with righteous indignation and dislike men who are beguiled and demoralized by the charms pleasure moment so blinded desire that they cannot foresee the pain and trouble.

Latest Portfolio

HOW PHYSIOTHERAPY CAN BOOST RECOVERY FROM SPORTS INJURIES

Custom-Made Orthotics: A Step Toward Better Foot Health

Recovering from Motor Vehicle Accidents: How Physiotherapy Can Help

Chiropractic Care for Chronic Pain: Realigning Your Spine for Long-Term Relief

ACUPUNCTURE: A NATURAL PATH TO PAIN RELIEF AND STRESS REDUCTION

THE ADVANTAGE OF USING COMPRESSION STOCKINGS FOR PREVENTIVE CARE

Need Any Help? Or Looking For an Agent

sendmail@example.com

Working Hours : Sun-monday, 09am-5pm

© 2022 Vankine. All Rights Reserved.