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Funding for Therapy and Counselling Online Application Form

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Funding for Therapy and Counselling: Eligibility and Requirements

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Funding for Therapy Application Flowchart

Questions?

We are available to speak with you about this process and help with any assistance you may require in completing your application. Please contact the Deputy Registrar & COO at the College. Call 1-800-583-5885 ext. 225 or email: fundingfortherapy@collegept.org.

Applying for Funding

The College of Physiotherapists of Ontario maintains a program to provide financial assistance for therapy and counselling for patients who have been sexually abused by a physiotherapist.

For health care providers in Ontario, the Regulated Health Professions Act (RHPA) defines sexual abuse not only as sexual intercourse with a patient, but also touching or remarks of a sexual nature directed towards a patient.

For applications to be approved at the staff level, an application must meet certain requirements. Review the complete list of requirements.

To apply, you can either complete the online application form below or download the application form and email to fundingfortherapy@collegept.org or mail it to:

Patient Relations Committee
College of Physiotherapists of Ontario
375 University Avenue, Suite 800
Toronto, Ontario M5G 2J5

Questions?

If you need the application form translated, need help completing the form or if you require a hard copy, please contact the College at fundingfortherapy@collegept.org.

Funding for Therapy and Counselling Online Application Form

Patient Contact Information

(Please answer as many questions as you can)

First Name of Patient

Last Name of Patient

Pronoun

Home Address

Suite/Apt.

City/Town

Province

Postal Code

Patient Email Address

Phone number

Type of phone number provided above: Home
Work
Mobile

I was sexually abused by: (provide physiotherapist's name):

Were you a patient of the physiotherapist named above while the sexual abuse occurred? Yes
No
Unsure

A complaint or report was made to the College of Physiotherapists of Ontario regarding this sexual abuse. Yes
No
Unsure

Therapist or Counsellor Contact Information (if known)

You do not need a therapist or counsellor in order to apply for funding. If you already have a therapist or counsellor, they can complete Therapist form to submit to the college.

Please note: Depending on the nature of the therapy or counselling, your request may need to be considered by the Patient Relations Committee

First Name of Provider (if known)

Last Name of Provider (if known)

Pronoun

Address

Suite/Apt.

City/Town

Province

Postal Code

Telephone

Email Address of Provider (if available)

Start Date of Therapy or Counselling (mm/dd/yyyy)

Open the calendar popup.

Is this therapist/counsellor a regulated health professional? YES, this therapist/counsellor is a regulated health professional.
NO, this therapist/counsellor is NOT a regulated health professional.
I don't know

If YES, please tell us what profession they are a member of:

Are the services of this therapist/counsellor covered by OHIP or another insurer? YES
NO
I don't know

If you have more than one therapist or counsellor please add their contact information

I intend to request reimbursement for out-of-pocket therapy or counselling costs YES
NO
I don't know

Confirmation and Permission to Contact *required

I confirm that:

I do not have a family or personal relationship to the Therapist or Counsellor or any other potential conflict of interest.
I understand that if I choose a Therapist or Counsellor who is not a regulated health professional they are not subject to professional discipline by the College of Physiotherapists of Ontario or any other regulatory body.
I understand that funding shall be paid only to the Therapist or Counsellor, and it shall be used only to pay for therapy or counselling for the sexual abuse that made me eligible for funding and shall not be applied directly or indirectly for any other purpose.
I understand that the maximum amount of funding payable to any Therapist or Counsellor approved under this or any other application to the College of Physiotherapists of Ontario is the amount that the Ontario Health Insurance Plan (OHIP) would pay for 200 half-hour sessions of individual out-patient psychotherapy with a psychiatrist not to exceed $17,370.
I will use the other sources of funding for therapy or counselling that are available to me first.
I understand that there can be no duplicate payment for the same service. To my knowledge OHIP or any other private insurer is not covering the costs associated with the therapy or counselling I receive from the Therapist or Counsellor. If at any time, OHIP or a private insurer can pay for the therapy or counselling, I shall notify the College of Physiotherapists of Ontario.
I understand that I will need to pay for any cancellation or late fees.

By checking this box, I confirm the seven statements listed above and I agree to allow the College of Physiotherapists of Ontario to contact the above-named Therapist or Counsellor, as necessary, to process my application for funding.

I CONFIRM the seven statements listed above as well as the information in this form and I ALLOW contact.

Application Date

Open the calendar popup.

Indicate today's date

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