Practice Advice

It can be frustrating when a patient is not able to attend appointments and, as a result, their treatment plan is not being followed. 

The Duty of Care Standard expects you, as a physiotherapist, to take responsibility for maintaining an effective therapeutic relationship. This includes supporting shared decision-making, recognizing that patients have the right to make informed decisions about their treatment plan, and meeting your duty to accommodate a patient’s needs. 

When a patient is frequently rescheduling their appointment or unable to attend treatment, you should connect with them to discuss the barriers that may be making it difficult for them to attend. 

Connect with your patient by phone, email, or whichever way they are most comfortable communicating with you. For some patients in Northern or underserviced areas, this could even be over a messenger service. 

Ask patients about possible barriers to attending their appointments. For example, patients may have concerns about: 

• Costs for physiotherapy care 

• Costs related to transportation or parking 

• Transportation challenges related to their injury, health or job 

• Schedule challenges or time to get to clinic  

• Feelings of comfort or safety 

• Lack of understanding about reasons for treatment schedule or attendance 

• Other personal or family issues 

Address these barriers thoughtfully and consider which barriers you may be able to control (for example, inviting the patient to attend with a family member to increase their feelings of comfort) and which may require you to discharge them with a referral to a more appropriate option (for example, from private pay to public-funded physiotherapy). 

Remember to keep a record of the conversation and solutions offered to address the barriers in the patient’s record.

Until they pass the Canadian Physiotherapy Examination (CPTE) and register in Independent Practice with the College, a physiotherapy graduate can work as a physiotherapist assistant (PTA). This means they can only provide physiotherapy care as directed by a registered physiotherapist who acts as their supervisor.  

As a reminder, PTAs cannot: 

• perform assessments or reassessments  

• communicate a diagnosis

• independently determine a treatment plan or goals of treatment

• discharge a patient 

• perform any part of acupuncture or dry needling, internal pelvic physiotherapy care, or spinal manipulation 

Physiotherapists who assign care to a physiotherapy graduate working as a PTA must meet the expectations of the Supervision Standard. This includes ensuring that the assigned care is appropriate, providing the required level of supervision, and remaining accountable for all care provided. 

No, the College does not recommend or approve specific courses or training when rostering for a controlled act. 

The Controlled Acts Standard sets out the training requirements to be able to roster, and it is up to you to ensure those requirements are met. The College does not require that this training take place in Ontario. 

To successfully roster for the controlled act, your course or training must include:  

A. Theoretical components, including: 

• indications 

• contraindications 

• adverse events 

• risks  

B. Practical components, including: 

• ability to practice the controlled act under supervision of an authorized professional 

• ability to demonstrate safe and competent performance of the controlled act to instructor/trainer 

C. Evaluation component, including: 

• evaluation of knowledge and judgement 

• evaluation of skills and practical application 

Take the time to review the standard and make sure your training meets the requirements. Once you have successfully completed your training, you can roster to perform the controlled act. Before performing the controlled act with your patients, create a written plan for how adverse events would be managed. 

Remember to verify that your professional liability policy covers you to perform the controlled act in your practice. 

Start by thinking about whether the information could affect the patient’s care and whether the patient is asking that it not be shared, not be documented, or both. Under the Personal Health Information Protection Act (PHIPA), a patient can ask that certain personal health information not be used or disclosed. This is sometimes called a lock box or consent directive.

If the information is relevant to the clinical picture – for example, if it could affect the treatment plan, continuity of care, or patient safety – it should still be documented in the patient’s record. A patient’s request does not automatically mean clinically relevant information can be left out of the chart. In other words, the patient can request clinically relevant information not be disclosed, but they cannot request that it not be included in the chart.

The central issue is not whether to document the information, but who can access it or receive it. For example, a patient may ask that specific information not be shared with a particular provider. If the information can be restricted without affecting safe and appropriate care, think about how you can respect the patient’s wishes while still meeting your professional obligations.

It is also important to talk with the patient about any possible impact on assessment, treatment planning, continuity of care, or safety so they can make an informed decision. If sharing may become necessary to support safe care, discuss this with the patient and seek consent again.

Considerations may include:

• What information does the patient want restricted?
• Could limiting access to the information affect safe and appropriate care?
• If sharing may become necessary to support safe care, have you talked this through with the patient and asked for consent?
• Have you documented the patient’s request, your discussion, and any decisions made?

If you are unsure how to respond, it may be helpful to review the Information and Privacy Commissioner of Ontario’s lock box fact sheet and seek privacy or legal advice.

All your billing, invoices and receipts need to be accurate and truthfully represent the physiotherapy services provided. In this situation, you could indicate that a parent received physiotherapy consultation or training related to their child’s care. However, you must clearly include on the physiotherapy invoice that the child – not the parent – is the patient receiving physiotherapy care, and that the parent participated in the child’s treatment session.

For example, the invoice could say, Physiotherapy care: Parent education/ training for Smita Patel (patient is Rajiv Patel).

The invoice or receipt must accurately reflect the time spent on parent consultation or training. If no parent involvement occurred, it should not be included on the invoice. A parent’s desire to maximize extended healthcare benefits must not compromise transparency or accuracy. Never misrepresent who the patient is.

The Funding, Fees and Billing Standard sets the expectation that billing practices for physiotherapy services and products are transparent, justifiable, and clearly communicated.

The College’s Code of Ethical Conduct requires that physiotherapists act transparently and with integrity in all professional and business practices, including fees and billing.

Submitting an account or charge for services that you know, or you ought to know, is false or misleading is an act of professional misconduct, according to the Professional Misconduct Regulation.

Ultimately, the insurer will determine if the services fall within the patient’s insurance policy and are reimbursable.

Here’s some advice from the Canadian Life and Health Insurance Association: “In the case where other parties are treated or billed for services in relation to a patient’s overall treatment (such as parent interviews for a child’s treatment), the name(s) of the individual(s) receiving the service(s) and the name of the patient for which the services are ultimately related must be clearly identified.”

You are not required to offer discounts or free care. However, if you choose to reduce or waive fees, your decision-making should be ethical, fair, and non-discriminatory.

The Code of Ethical Conduct and the Duty of Care Standard require you to provide care and make practice decisions in a way that respects patient dignity and complies with the Ontario Human Rights Code. This also applies to decisions about who receives discounts or free care. 

If you choose to offer discounts or free care: 

• Be equitable: Your decisions should be based on financial need or access to care, not personal bias.

• Be consistent: Similar situations should generally be treated in similar ways.

• Be transparent: You should be able to explain why a discount was offered if asked.  

When discussing financial difficulties with a patient: 

• Keep the conversation respectful and private. 

• Do not pressure patients to prove financial difficulty. This could violate the professional boundaries of the therapeutic relationship.

Quick self-check 

Before offering a discount or free care, ask yourself: 

• Is this decision free from bias or discrimination? 

• Is it based on access to care or financial need? 
• Am I applying this approach fairly across patients? 
• Would I be comfortable explaining this decision to the College? 
• Have I respected the patient’s dignity and privacy? 

Remember that invoices provided to patients must accurately reflect what they were charged. No invoice is required if care is provided for free.

The College does not have specific rules about how often reassessments must occur. Use your professional judgment to decide when a reassessment is necessary. 

To inform your judgement, collect enough subjective and objective information to support your clinical decisions. Re‑evaluate your patient’s status throughout the course of care to make sure treatment remains safe and effective. This process is also called clinical reasoning. Your clinical reasoning should include using standardized measures (where available) and be evidence-informed. 

Common situations that may prompt a reassessment include: 

• changes in the patient’s condition or symptoms 

• progress toward goals or changes in goals 

• the emergence of new concerns that were not previously assessed 

• the amount of time that has passed since the patient was last seen 

• contextual or workplace factors that may affect how care is delivered 

Consider these factors together and in context to help you decide whether your existing assessment information is sufficient to support ongoing care or if you need to complete a new assessment. 

The takeaway? Reassessment is based on clinical judgement, not solely on the calendar. Reassess based on your patient’s needs, not routine intervals. 

Fixed reassessment schedules can lead to unnecessary visits and may create barriers for patients if additional fees apply. 

No, short vacations do not need to be reported to the College. You are not required to update your employment information for short, temporary absences from work, and these periods should not be entered with an end date in your employment history. 

However, if you are taking a leave of absence from practice (for example, parental leave, medical leave, or another extended period away from work), you are required to update your profile in the PT Portal. This typically involves updating your employment status in your profile and adding an end date to your current employment to reflect the start of your leave. When you return to practice, you would then add a new employment entry with the appropriate start date. 

Please note that practice hours cannot be claimed for any period of vacation, sick leave, or leave of absence.  

Professional obligations (such as annual renewal and PISA) continue to apply while on leave, if you have chosen to keep your certificate of registration active during this period. 

If you ever need assistance updating your profile, please contact the Registration Team. They will be happy to help. 

No. Under Ontario law, physiotherapists must not provide treatment to anyone with whom they have a sexual relationship, including a spouse or partner. 

For physiotherapists in Ontario, spouses and sexual partners are  not exempt from the definition of sexual abuse. This means that if you attempt to treat your spouse or partner as a patient, it will be considered sexual abuse given the pre-existing sexual relationship you have with them. 

The only exceptions are when care is provided in an emergency, or when care is minor in nature. In both cases, no fees can be charged. 

• Emergency treatment means urgent, short-term care that cannot reasonably be delayed until another provider is available, and where no practical alternative for timely care is available. For example, offering first aid at the scene of an accident. 

• Minor treatment means care that is brief, low-risk, and does not establish or continue a therapeutic relationship. For example, applying a bandage, giving quick advice on safe movement after an acute strain, or helping with positioning at home. 

These exceptions are meant to ensure that spouses are not left without help in urgent or minor circumstances. They do not allow physiotherapists to take on their spouse or partner as a patient, provide ongoing care, or bill for services. 

If you do need to treat a spouse or partner for the reasons outlined above, you must document what emergency assistance or minor treatment was provided. 

Indigenous patients in Ontario still face racism, unfair treatment and have a harder time getting the health care they need, including physiotherapy. 

Indigenous Patient Navigator programs were created to help improve access to health care for Indigenous people. These programs support Indigenous patients and their families by helping them find care that is culturally safe and respectful. Having Indigenous Patient Navigators in different health-care settings can also help reduce racism against Indigenous people in those spaces.  

In clinical settings, Indigenous Patient Navigators can: 

• Act as liaisons between clinical, community and social services 

• Assist a patient’s health journey through traditional healing, traditional practitioners, medicines, and cultural practices 

• Collaborate with physiotherapists to address the needs of Indigenous patients, informed by factors like intergenerational trauma and the enduring impact of colonialism 

• Assist with navigating services and care across the health-care system 

• Identify and address challenges and barriers to care 

• Assist and collaborate with discharge plans 

• Open lines of communication between patient and physiotherapist  

• Support patients and their family members to understand and participate in their physiotherapy treatment plans 

Here are some Indigenous Patient Navigator programs across the province: 

Province-wide 

• Cancer Care Ontario 

Southwestern 

• De dwa da dehs nye>s Aboriginal Health Centre (Hamilton, Brantford/Haldimand, Niagara) 

• Niagara Health 

• Hamilton Health Sciences 

• London Health Sciences 

• Brant Community Healthcare System 

• Bluewater Health – Sarnia 

• Southwest Regional Cancer Program (London) 

Greater Toronto Area 

•  Toronto – Univerisity Health Network 

• Lakeridge Health/Royal Victoria Regional Health Centre 

• Southlake Health 

• Scarborough Health Network 

Eastern  

• Kingston Health Sciences Centre – Kingston 

Northern 

• Thunder Bay Regional Health Sciences Centre 
• St. Joseph’s Care Group – Thunder Bay
• Sioux Lookout Meno Ya Win Health Centre
• Lake of The Woods District Hospital

• Georgian Bay General Hospital 

• Health Sciences North – Sudbury 

• Brightshores Health System – Owen Sound 

• Timmins and District Hospital

If you have a patient who could benefit from support in their journey through the health-care system, please reach out to your local Indigenous Patient Navigator. If you need help finding someone in your area, please contact a Practice Advisor at advice@collegept.org.  

Yes, but there are some considerations.  

The Advertising and Marketing Standard requires that physiotherapists only advertise free physiotherapy services, such as free consultations, assessments or trials of clinically indicated physiotherapy treatments, in a manner that:   

• Promotes general education or health awareness.  

• Informs the public about any conditions or limitations related to the physiotherapy services offered.  

• Highlights pro-bono services offered to patients experiencing financial hardship.  

The Funding, Fees and Billing Standard states that physiotherapists may reduce fees (includes waiving fees). Physiotherapists must ensure invoices/receipts accurately reflect charges and discounts.  

If you are providing any physiotherapy care, including a free consultation or assessment, you must follow all standards, including having a patient record. Physiotherapists must not provide care of lesser quality because there is a promotion attached. Physiotherapists also must not provide unnecessary care. 

Physiotherapist must ensure that they have the patient’s consent to provide an assessment. Be sure to document the reasons why fees are being waived in the patient’s chart. 

Any communication that is relevant to the clinical picture must be included in the physiotherapy record.  

Information that’s not related to the patient’s condition or care does not need to be recorded – for example, if you explained how to fill out insurance forms or where to buy equipment. 

Here are some key types of communication that must be included, according to the Documentation Standard: 

• Date of each treatment session or professional interaction including declined, missed or cancelled appointments, telephone or electronic contact. 
  • Why – Including the dates of declined, missed or cancelled appointments can provide important information about the pattern of attendance and may provide insight into the patient’s condition and outcomes of care.   

• Details of relevant patient education, advice provided, and communication with or regarding the patient that is related to clinical care. 
  • Why – Information about changes in symptoms or treatment should be documented in order to understand the care that was provided and the impact. 
  • Example – You should document if a patient contacts you to report that their symptoms got worse after a new exercise was added to their home program. You should also record any advice you gave them. 

• Documentation of any patient safety incidents, including near misses. 
  • Why – By including patient safety incidents and near misses, you and others can learn from them and prevent future issues 
  • Example – If a patient almost falls off a stationary bike during an appointment, document it. Consider what safety elements could be included during their next visit (such as a one-person assist at time of dismount).