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Call : +1 (416) 249-8668

Email : info@trinityrehab.ca

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Looking for the Best Physical Rehab?

Call : +1 (416) 249-8668

Email :info@trinityrehab.ca

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About Us
Our Services
Patient Center
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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

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

PATIENT INFORMATION

Patient Name:

Referring Physician:

Rx Date:

Date of Birth:

PHYSICAL REHABILITATION SERVICES - DIAGNOSIS:

COMPREHENSIVE THERAPIES (Includes Physiotherapy, Massage Therapy, Chiropractic & Acupuncture)

Physiotherapy

Osteotherapy

Massage Therapy

Chiropractic Treatment

Acupuncture Therapy

Workplace Injury Rehab (WSIB)

Slip & Fall Rehab. / Personal Injury

Motor Vehicle Accident Rehab (MVA)

ORTHOPAEDIC DEVICES - DIAGNOSIS:

Compression Stockings / Socks

20-30 mmHg

30-40 mmHg

Orthopaedic Shoes / Shoe Modification

TENS Machine for indeterminate use (Transcutaneous Electrical Nerve Stimulation)

Orthopaedic Brace / Support

Mobility Aids / Assistive Devices - Diagnosis:

Walker / Rolator

Crutches

Wheel Chair

Postural Correction Brace

Cane

Cervical Pillow

Back Support Pillow

Neck Collar

X-Rays:

Other:

Ultrasound:

Referring Physician Signature / Stamp:

Special Note:

Request an Appointment

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ACUPUNCTURE: A NATURAL PATH TO PAIN RELIEF AND STRESS REDUCTION

THE ADVANTAGE OF USING COMPRESSION STOCKINGS FOR PREVENTIVE CARE

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