Intake Form

    INITIAL INTAKE FORM

    Welcome to Goreway Physiotherapy & Rehabilitation Centre! In order to serve you better, please take a moment to complete this form. If you require assistance, please see the receptionist. When finished, kindly return this form to the front desk.


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    Automobile Accident

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    Sports Injury
    Others

    Driver's LicenseHealth Card (OHIP)Police ReportInsurance Pink SlipExtended Health Benefits CardOthers