Contents

Ontario physiotherapy intake form checklist

Ontario physiotherapy intake form checklist

Why a checklist matters

Ontario rehab clinics see extended-health, WSIB, MVA, post-surgical, and tele-rehab patients — often in the same week. Each track adds documents. Without a checklist, reception rebuilds the request from memory every time.

Core new-patient items (extended health)

  • Health history questionnaire (client-centred language)
  • Informed consent for assessment and treatment
  • Government-issued photo ID
  • Extended health benefits card (front and back)
  • Insurer policy or certificate number
  • MD/NP referral letter where required by the payer
  • Prior imaging or specialist reports (if applicable)

WSIB addendum

  • WSIB claim number
  • Employer name and contact
  • Date and mechanism of injury
  • Prior treatment records
  • Employer or case-manager correspondence

Form 8 is completed by the treating clinician within 48 hours via TELUS Health — not collected as a patient upload through Hivi-X.

MVA addendum

  • Adjuster name, contact, and claim number
  • Accident date and brief circumstances
  • Police report or incident number (where applicable)
  • Hospital discharge summary or ER records

Tele-rehab addendum

  • Consent for virtual assessment and treatment
  • Remote health history confirmation
  • Home environment safety screening notes

Office manager sign-off

Before the visit, confirm checklist completeness. Hivi-X shows missing items on a dashboard and exports an organized package for Jane, Cliniko, or your EMR.

Download the free PDF checklist.

General operational information for Ontario physiotherapy and rehabilitation clinics only — not legal, clinical, privacy, or billing advice. Your clinic remains the health information custodian under PHIPA. Hivi-X is document-collection software; it is not an EMR, does not submit WSIB Form 8, and does not certify college or PHIPA compliance.

Answers are general operational information only — not legal, tax, regulatory, clinical, privacy, immigration, or professional advice. Requirements vary by matter, client, and regulator.

Frequently asked questions

What should an Ontario physiotherapy intake checklist include?
Health history, consent, government ID, benefits card, policy number, MD/NP referral if required, WSIB claim details for work injuries, MVA adjuster info for auto claims, prior imaging or discharge summaries when relevant, and tele-rehab consent for virtual visits.
Is this checklist college-mandated?
No. This reflects common clinic practice. Verify requirements with insurers, WSIB, CPO, CCO, CMTO, and your privacy officer.
Can I download a PDF version?
Yes. Get the free Ontario Physiotherapy & Rehab Clinic Intake Document Checklist at hivi-x.ca/physiotherapy/ontario-physiotherapy-intake-form-checklist.

Collect complete patient intake before the appointment

Hivi-X helps Ontario physiotherapy and rehabilitation clinics request health history, consent, insurance cards, referrals, and WSIB/MVA documents with reusable checklists, a secure guest link (no account needed) or my-id.ca portal, self-hosted AI summaries, and exportable packages for Jane, Cliniko, or your EMR.

Ontario Physiotherapy Intake Form Checklist | hivi-x Docs