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Atc spasticity clinic
Gait Technology Program 3560 Bathurst St., Main Floor,Toronto, ON M6A 2E1 Telephone: (416) 784-3600 Fax: (416) 784-5600 REQUEST FOR CONSULTATION PATIENT NAME: HEALTH CARD: DATE OF BIRTH: WORK/CELL: ADDRESS: *PLEASE ATTACH MOST RECENT MEDICAL REPORT* REFERRING DR.: BILLING #
Able to follow instructions Able to ambulate 25 feet with or without assistive device Able to attend 3 times/week for 4 weeks Ability to follow instructions, do homework and learn Able to co-pay for a 12 session program new skills Please check if any of Private Insurance Veterans Affairs these apply: Then include relevant information: Case/Claim/ODSP #: _____ pages Contact/Case manager: Program Stream: Gait and Balance Training Gait Technology Program including Ness L300™ Device Assessment
*Physicians that recommend the Gait Technology Program are required to complete this form: 1- Special approval for Ness L300 Device required by Physician if patient has (please check): 2- EMG is used as a screening tool by ATC to determine candidacy for functional electrical stimulation.
NOTE: Patients with foot drop as a result of diabetic neuropathy or failed back surgery may not be candidates for FES
device, but an EMG confirming eligibility may be provided at ATC.
Please Fax your referral and most recent medical report. IMPORTANT NOTICE ON CONFIDENTIALITY: Thank you for your referral to the ATC. The contents of this fax transmission contain confidential information intended for the person(s) named above. Any copying, disclosure or distribution is strictly prohibited. In the event that this fax was received in error, please notify us immediately by phone and destroy this document.
Raving about Rhodiola (Rhodiola rosea) Rhodiola wasn’t an herb I was taught in herbal college, thus it is a fairly new addition to my dispensary cupboard. Yet, the more I learned about this herb, the more I had to have it! Its potential for my clients is too great not to!Rhodiola (Rhodiola rosea), also known as Stonecrop, Roseroot or Golden Root, among other names, is a member of the fami
Pakkausseloste: Tietoa käyttäjälle ASPIRIN® ZIPP 500 mg rakeet Lue tämä pakkausseloste huolellisesti, ennen kuin aloitat tämän lääkkeen käyttämisen, sillä se sisältää sinulle tärkeitä tietoja. Käytä tätä lääkettä juuri siten kuin tässä pakkausselosteessa kuvataan tai kuin lääkäri tai apteekkihenkilökunta on neuvonut sinulle. - Säilytä tämä pakka