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Email Referral Form

Client Information

Additional Notes

Disclaimer:

Important Note: By pressing submit, this form and the information on this form will be transferred by email to Complex Injury Rehab Inc. Once received, Complex Injury Rehab Inc. is committed to ensuring confidentiality and privacy, as outlined in our privacy policy. However, Complex Injury Rehab Inc. is not responsible or liable for any possible breach of confidentiality during the transmission process.

We are an experienced team dedicated to maximizing your potential for brain, spine and mental health.

Phone: 647-725-2633