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Forms: Health care practitioners

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Form Number Form Name
Reports
0008A (PDF)

Health Professional's Report (Form 8)

This form should be used for work-related physical injuries and illnesses.

For more information refer to the commonly used forms webpage.
CMS8 (PDF) Health Professional’s Report for Occupational Mental Stress (Form CMS8)

This new form should be used for work-related mental stress disorders or conditions.

For more information, refer to the Form CMS8 frequently asked questions page or the commonly used forms webpage.
 

0278A (PDF)

Dental Report
0856C (PDF)

Physiotherapy Assessment Report 

0896A (PDF) Health Professional's Progress Report (Form 26) View Only
2234A (PDF) Health Professional Continuity Report (Form REO8)

1787A (PDF)

ENT Consultation Report
2647A (147.0kb, PDF)

Please check your fee schedule for updated FAF fee.

Read our Guide to Completing the Functional Abilities Form (PDF)

Treatment Extension Requests

Note: Do not submit treatment extension requests forms for workers who are currently being treated under the Programs of Care or Episode of Care. Health Care Providers should call the Clinical Expert Line to discuss case specific clinical concerns. For further information, please refer to the Q&A documents available under the Programs of Care.

0148A (PDF)

Chiropractor's Treatment Extension Request

0153A (PDF)

Physiotherapist's Treatment Extension Request
Health Information Requests

1801A (PDF)

Request for Hospital Medical Information

1823A (PDF)

Request for Hospital Medical Information: Occupational Disease View Only 

2012A (PDF)

Request for Health Information View Only
Other Requests

2869A (PDF)

Hearing Aid Special Needs Request

2889A (PDF)

Hearing Aid Early Replacement

1923A (PDF)

Notice of Temporary Assignment of Practice for Chiropractors

3947A (PDF)

Provider Payment Request
3941A (PDF) Provider Payment Request for Equipment/Supplies
Program of Care
0916A (PDF) Instructions for Delivering Programs of Care
2345A (PDF) Musculoskeletal Program of Care: Initial Assessment Report
2339A (PDF) Musculoskeletal Program of Care: Care and Outcomes Summary (discharge form)

0037A2 (PDF)

Program of Care NIHL Hearing Aid Outcome Report
2522A (PDF) Shoulder Program of Care Initial Assessment
2524A (PDF) Shoulder Program of Care Care and Outcomes Summary
3238A (PDF) Program of Care for Low Back Injuries Initial Assessment Report
3239A (PDF) Program of Care for Low Back Injuries Care and Outcomes Summary
3240A (PDF) Program of Care for Mild Traumatic Brain Injuries Initial Assessment Report
3241A (PDF) Program of Care for Mild Traumatic Brain Injuries Care and Outcomes Summary
Non-Surgical Fracture Episode of Care
2610A (PDF) Initial Assessment Report
2611A (PDF) Summary Report
Order Forms
1904C (PDF) Order Form for Health Professionals' Forms
2929A (PDF) WSIB Policy Manuals/Newsletter Order Form

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