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