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    Injuries

    Soft Tissue - NeckSoft Tissue - BackTMJ - JawHeadachesFracturesCutsArmsLegs

    Medical Treatments

    AmbulanceHospitalFamily DoctorSpecialistPhysiotherapyMassage TherapyChiropractic

    Is there an income Loss Claim?

    YesNoUnsure

    Accident Description

    Upload Collision Report

      Are you still in active treatment?

      YesNo

      If so what treatment

      PhysiotherapyChiropracticMassageTMJ / DentalAcupunctureOther

      Has your AB (Auto) Insurer given an extension on the number of treatments for direct billing?

      YesNoUnsure

      Has any treatment been recommended, but hasn't occurred? Can you provide details

      What injury symptoms do you currently have?

      Who is paying for treatment now?

      AB Insurer (Your Auto Insurer)Extended Health Care BenefitsAlberta Health CareMyselfUnsure

      Unreimbursed Treatment Receipts

      Do you have any questions or concerns that I can assist with?

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