First name *
Last name *
Email address *
Address *
City *
Province *
Postal Code *
Country *
Daytime telephone number *
Type of report
Other Information
Name of the Physiotherapist *
Specific details related to the incident(s) that led to the filing
of the report *
Name and contact information of any possible witness(es)
Describe any supporting documentation that is available
Where the report is related to an offence, finding of negligence or finding of malpractice,
please provide the following:
- name of the physiotherapist filing the report
- nature of and a description of the finding or offence
- date that the finding was made against the physiotherapist
- name and location of the court that made the finding against the physiotherapist;
- status of any appeal initiated respecting the finding made against the physiotherapist
Include Documents(optional)
If you wish to include supporting documents with your complaint, please attach here.
File type allowed(.doc, .docx, .pdf, .jpg, .jpeg, .zip, .xls, .xlsx, .txt) and file size should not exceed 10MB each
By clicking Send, I understand that I am submitting a mandatory report to the College.