Consent to Release of Information
By signing this release, I am agreeing to the following:
I hereby acknowledge that I authorize MOVE Physiotherapy Inc to contact, speak to and share any pertinent information surrounding my claim and health with the Worker’s Compensation Board of Nova Scotia, or my Motor Vehicle Insurance company. Whichever is appropriate considering my specific claim and injury.
I understand that I have the right to revoke this consent provided that I do so in writing, except to the extent that MOVE Physiotherapy Inc has already disclosed information based on this consent.