The purpose of this form is to enable the patient to provide his /her employer with confirmation that his/her absence from work is due to illness or injury. Completion of this form is an uninsured ...

I consent to my physician, psychiatrist, psychologist, counsellor, or social worker reviewing my personal health information in order to provide it to me as requested on this form. I understand that ...

Return the completed application form with any supporting documentation to the following address by e-mail to: [email protected] Should there be no alternative, e-fax (or facsimile) can be ...