Referral Forms for Lawyers, Physicians & Case Managers
Forms for new clients, and referral routes for lawyers, healthcare providers and case managers.
If a form is holding you up, call us. We would rather complete it with you over the phone than have paperwork stop you getting treatment.
Client Forms
These are completed at or before your first appointment. You do not need to have them ready in order to book, and we can go through any of them with you.
New Client Intake
Your contact details, health history, the accident if there was one, and what you are hoping for from treatment.
Available on request — call or email and we will send it to you.
Consent to Treatment
Explains what treatment involves, the limits of confidentiality, and your right to withdraw at any point.
We go through this with you rather than asking you to sign something unread.
Consent to Release Information
Authorizes us to share information with a specific person or organization, such as your lawyer, physician, insurer or case manager.
You choose what is shared and with whom, and you can withdraw it later.
Direct Billing Authorization
Allows us to bill your insurer directly, so approved treatment costs you nothing out of pocket.
Required for accident benefits and most extended health plans.
Cancellation Policy
What happens if you need to cancel or reschedule, and how much notice we ask for.
We know pain, fatigue and transport problems are unpredictable. Talk to us.
Privacy Policy
How we collect, store, use and protect your personal health information, and your rights under Ontario privacy legislation.
Referral Routes
A brief note is sufficient. We will contact the client directly to arrange assessment, and we complete the insurer paperwork.
Lawyer Referrals
Send us the file and we read all of it. We identify what the clinical record establishes, where it is incomplete, and which further assessment is clinically indicated, before you commission anything.
Healthcare Provider Referrals
Physicians and nurse practitioners can refer for assessment, treatment, TMS, neurofeedback or catastrophic determination. You receive acknowledgement, findings and scheduled progress reporting.
Case Manager Referrals
Assessments that answer the question your file needs answered, and the treatment that follows from them, with progress reporting delivered to an agreed schedule.
How to Send a Referral
The quickest route is our online referral form, which reaches our intake team directly.
Submit a Referral OnlineIf you would rather not use the form:
- Phone 289-547-5911
- Toll free 1-866-248-0567
- Email info@criticaltraumatherapy.com
- Fax 289-426-3227
Please include what you are asking us to address, relevant history, and whether an insurer or lawyer is involved.
Send a Referral Online
Our online referral form takes a few minutes and goes straight to our intake team. You will hear back from us, and we will confirm what happens next.
The Forms We Complete for You
You should not be filling in insurance forms while injured. We complete and submit your OCF-18 treatment and assessment plans, track your insurer’s ten-business-day response deadline, prepare progress reports, and respond in writing where treatment is denied.
Income support matters just as much, so the supporting documentation for Ontario Works, ODSP and CPP Disability is prepared here too, and benefit coverage is not lost to unfinished paperwork.
There is a good deal more that people do not realise we can help with:
- Employment Insurance sickness benefit certificates
- Disability insurance forms from your employer’s plan
- Disability Tax Credit certification
- ODSP special diet allowance forms
- Assistive Devices Program authorisations
- Letters supporting school or college accommodations
Where a form requires a prescriber’s signature, we will let you know whether we are able to complete it.
If a form arrives that you do not understand, send it to us and we will explain it or complete it with you.
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