Telehealth

Are you an existing member?
YesNo
Do you have access to a smartphone or a computer with a web cam?
YesNo
Area of Injury
Is this a new injury?
YesNo
If it is a new injury, details:
Have you consulted your GP with this injury?
YesNo
A STAFF MEMBER FROM CSPORTR WILL CONTACT YOU TO DISCUSS YOUR ELIGIBILITY FOR TELEHEALTH AND TO SCHEDULE AN APPOINTMENT.
By signing this document, I consent to a physiotherapist from CSPORTR to contact me for the purpose of a telehealth treatment.
Your signature below
Date