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Motor Vehicle Accident

At Integra Health Centre, we strive to begin your treatment as soon as your examination is finished. We’ll work with your insurance company to ensure that your treatment costs are covered.

Our team is dedicated to providing comprehensive care for your motor vehicle accident injuries. We’ll help you stay active during your recovery with personalized home exercises and effective pain management techniques.

We are fully equipped to handle the submission of all the required claim forms and paperwork to the insurance companies on your behalf. To ensure a smooth and hassle-free process, we encourage our patients to promptly fill out the necessary claim forms below to initiate the reimbursement process with their insurance provider.

For more information about our Motor Vehicle Accident, please contact us at 416-777-9355 ext 2 or you can email us at intake@integrahealthcentre.com.

Fill out your mva claim insurance form here

Frequently Asked Questions

Extended

Benefit Plan

A doctor’s referral is not required. However, some extended insurance plans may require one to provide reimbursements. You can book an appointment with one of our in-house physicians to obtain a note if you do not have a family doctor.

Our Allied services are often covered by most extended health benefits plans, but we advise you to check with your insurance provider to confirm coverage.
Please note that we don't do direct billing.

If you need help or have any questions regarding the form, please email us at:
intake@integrahealthcentre.com

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patient INFORMATION

Please state your first and last name*

Please state your address*

Email Address*

Date of Accident (MM/DD/YY)*

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Auto Insurance legislation requires that your Extended Health Benefits (EHB's) are used prior to accessing the auto insurance funding. If you have more than one source of EHBs i.e. personal and spousal, we are required to bill both insurers.
‍
Whenever possible we will bill your EHB insurer directly to streamline the process of coordinating both funding streams.

Do you have extended health coverage for the following services:

Chiropractic

Physiotherapy

Registered Massage Therapy

Other

Extended Health Insurance Company Name

Policy Holder Name

Policy Number

Group Number

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PRIMARY INSURANCE INFORMATION

The laws in Ontario require that all invoices related to your treatments for injuries sustained in a Motor Vehicle Accident be submitted to your private/employer health insurance provider if available.

Insurance Company Name

Policy/Group #

ID/Certificate #

Policy Holder's name

Policy Holder's Date of Birth (MM/DD/YY)

Insurance Company Name

secondary INSURANCE INFORMATION

Policy/Group #

ID/Certificate #

Policy Holder's name

Policy Holder's Date of Birth (MM/DD/YY)

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AUTO INSURANCE INFORMATION

Auto Insurance Company NameAdjuster Name

Adjuster Contact Information

Policy Holder Name

Policy Claim Number

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LEGAL REPRESENTATIVE INFORMATION

Legal Representative Company Name

Legal Representative's Name

Legal Representative's Address

Legal Representative's Contact Information

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I hereby authorize Integra Health Centre to collect and release medical records, copies of treatment plans and financial and any other information related to my claim to above mentioned legal representative and third party payers (Private Insurance payer and Car Insurance).
I understand that I am legally responsible for providing Integra Health Centre with all information for my claim including any updates.
I direct all third party payers to pay Integra Health Centre directly for fees related to services provided for my injuries to this claim.
In the event of any settlement or agreement with the insurance company, I will ensure all the unpaid services at Integra Health Centre for my injuries are paid in full including any interest. I understand that I will remain responsible for any unpaid balance.
I understand I must exhaust my extended health benefits before the clinic switches over to using my Auto Insurance, and it is only once the Auto Insurance is in effect that Integra Health will direct bill for services and it's my responsibility to claim any out of pocket expenses directly with the insurance company (we can assist in providing expense claim forms).
I authorize Integra Health Centre to securely store my credit card information for payment purposes only.
It is my responsibility to pay for the full missed appointment fee if I fail to notify Integra Health Centre of my cancellation or rescheduling within the 24 hour cancellation policy.

Please check the below box if you agree to our terms of service above

I have read and agree to the Terms of Service above

Thank you! Your submission has been received!

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