Chiropractic Services Now Available:

call or fill out the form below to book in!

Book an appointment: (902) 832-6699 Phone Email Online
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  • Services
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Intake Form + COVID-19 Screening

  • Personal Information

  • Date Format: DD slash MM slash YYYY
  • Consent for Release of Information

  • I authorize MOVE Physiotherapy to use and disclose my medical information for purposes of treatment, payment and health care to the following:

  • Date Format: MM slash DD slash YYYY
  • 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 has already disclosed the information based on this consent.

  • Health History

  • Date Format: MM slash DD slash YYYY
  • 1 - No pain2345678910 - Worst pain ever
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Cancellation/Late Policy

    If you are unable to attend your scheduled appointment you are responsible for cancelling that appointment with 24 hours notice. If you fail to do so, you MAY be charged a $25 fee. If calling outside of business hours, please leave a detailed message. If you arrive 15 minutes or more past your scheduled appointment time you may be asked to reschedule and you MAY be charged a 25$ fee.

  • Payment Agreement

    MSI does not cover any of our services; therefore you, the client, are responsible for payment of services rendered. Payment is due at the time of your appointment. Many clients have private health benefits to offset the cost of our services. We direct bill Blue Cross and all Companies part of Teuls Health. Worker’s Compensation Board and Motor Vehicle Insurers. It is your responsibility to know the details of your plan. If you are covered under more than one policy, please note that we will only bill the primary policy. Any fees above this amount are your responsibility. (MOVE Physiotherapy reserves the right to refuse direct billing to any insurance company).

  • Please Note: If your claim is refused or denied by Worker’s Compensation Board, your Motor Vehicle Insurer or your personal Healthcare Insurer, you are responsible for all payments for services rendered. These fees may include, but are not limited to the following: treatment fees, product fees and fees for any forms completed during treatment.

  • By submitting this form, you are acknowledging MOVE Physiotherapy’s Cancelation/Late Policy and Payment Agreement
  • COVID-19 Screening

  • If you answered YES, to any of the above symptoms you are not allowed to enter the clinic at this time. As per Nova Scotia Public Health Regulations, you should self-isolate at home, and call 811

    Possible exposure sites: https://novascotia.ca/coronavirus/alerts-notices/#possible-exposures
  • If you answered YES, to any of the above then you are not allowed to enter the clinic at this time. We can book you for a TeleHealth appointment or we can reschedule you for 2 weeks from now. It is recommended you go to https://novascotia.ca/coronavirus/when-to-seek-help/ for more information on when to seek help/call 811

  • I confirm that the information given in this form is true, complete and accurate

Forms

  • Intake Form
  • COVID-19 Screening Form
  • Intake Form + COVID-19 Screening
  • Motor Vehicle Accident (MVA) Information Form
  • Workers’ Compensation Board (WCB) Information Form
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  • About
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