Book with Green Shield

Book an Appointment

$ 79.00

Evaluation

$ 79.00

Follow-up Sessions

Fees will only be charged on completion of your session. Phzio will attempt to collect payment directly from your carrier providing you identify valid policy details.

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First Name

Last Name

Name missing or invalid

Birth Date

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Email Address

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Mobile Number

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Register a way to pay

The Evaluation is $79.00. No charges are taken at this time, until the session has been completed. In case we can't direct bill your insurance or there is a co-payment required, we will use this information to collect payment.

Booking Confirmed

We have completed a secure capture of your payment option. You will only be charged on completion of your visit with your provider.

The next steps are recommended to ensure your provider has as much information as possible to provide effective care.

We highly recommend you complete these next steps and it should only take you a few minutes.

Gender

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Language Preference

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Address

Address (line 2)

City

Province

Postal Code

Emergency Information

Emergency Contact Name

Emergency contact missing

Emergency Number

Phone Number for emergency contact missing or invalid

Extra Info: Green Shield

Insurance Company

Identification Number

Relationship to Policy Holder

Coverage Type

Policy Holder Full Name

Policy Holder Birth Date

Move the circle to the area of greatest concern

Set a Profile Picture

You can skip this step, but this assists your provider with in-session identification.

Medical History

Family History

Select if any of your biological parents or grandparents had any of these conditions (check all that apply):

Arthritis

Osteoporosis

Stroke

Thyroid disease

Diabetes

Cancer

Psychological

Hypertension

Heart disease

Current Medications

List all current medications, and how you take it:

Medication Name / Dose	Add/Remove

Prior Surgeries and Dates

Indicate the nature and date of any surgeries you have had:

Nature of Surgery	Date of Surgery	Add/Remove

Additional Details

Indicate other details which would be useful for your specialist in understanding your needs:

You will be able to change these details at any time using the link for Medical Details in your welcome email. All accesses to these details are monitored and you will receive a notification every time you access these medical details.

Connect with your phone, tablet or computer. You should receive an email with your appointment details. We will remind you via email and text message on the day of your appointment to join the session.

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