#1 - 140 First Avenue West, Qualicum Beach, British Columbia V9K 2R5, Canada

Appointments: {250-752-3212}

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Qualicum Physiotherapy Clinic

Qualicum Physiotherapy ClinicQualicum Physiotherapy ClinicQualicum Physiotherapy Clinic

Regular Patients

For most patients, these forms are all you need to get started

New Patient Form (pdf)Download
Privacy Policy (please review) (pdf)Download
Extended Health Consent Form (pdf)Download
Benefit Assignment Form (pdf)Download

IMS / Dry Needling

IMS Info/Consent Form (doc)Download

ICBC - Outcome Measures

Lower Extremity Functional Scale (pdf)Download
Neck Disability Index (pdf)Download
Arm, Shoulder and Hand (pdf)Download
Low Back Oswestry Scale (pdf)Download

WorksafeBC forms

WSBC - Initial Appointment (doc)Download
WSBC - JOB DEMANDS QUESTIONNAIRE (pdf)Download
WSBC - Claim Status and Appointment Cancellation Policy (doc)Download

Telehealth

Telehealth Info and Consent Form (pdf)Download

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