Physicians Forms Clear your cache When completing our forms online, please ensure that you clear your browser’s cache afterwards. To clear your cache: 1. On the Tools menu in Internet Explorer 6, click on Internet Options. 2. On the General tab, in the Temporary Internet Files section, click on the Delete Files button. 3. Click on Ok and then click on OK again, at the bottom of the box. Learn how to complete our forms Forms Simplification Project The WSIB revised the 'Progress Reports' and 'Continuity Reports' families of forms. Forms Order Line 416-344-3862 (available 24 hours daily) 1-800-387-5540, ext. 3862 (available during business hours) Form Name Form Number Health Professional's Report (Form 8) We encourage you to use the new Health Professional's Report [Form 8]. For this new form, we pay a fee of $33.00. We developed the new form to get timely, complete and legible reports, allowing prompt adjudication. 0008A (486k, pdf) Old Form 8 The older version of the Health Professional's Report (Form 8) is still available. For the old version we pay a fee of $23.54. Old Form 8 (178k, pdf) Chiropractor's Treatment Extension Request 0148A (154k, pdf) Physiotherapist's Treatment Extension Request 0153A (154k, pdf) Regional Evaluation Centre Multidisciplinary Health Care Assessment Summary Report 0238A (125k, pdf) Regional Evaluation Centre Multidisciplinary Health Care Assessment Referral Form View Only 0239A (24k, pdf) Chiropractor's First Report 0284C (160k, pdf) Dental Report 0278A (411k, pdf) Physiotherapy Assessment Report 0856C (156k, pdf) Health Professional’s Progress Report (Form 26) View Only 0896A (303k, pdf) Voluntary X-Ray & Pulmonary Function Test 1087A (165k, pdf) ENT Consultation Report 1787A (184k, pdf) Request for Hospital Medical Information View Only 1801A (37k, jpg) Request for Hospital Medical Information: Occupational Disease View Only 1823A (37k, jpg) Health Professional's Registration Application 1890A (141k, pdf) Order Form for Health Professionals' Forms 1904C (233k, pdf) Notice of Temporary Assignment of Practice for Chiropractors 1923A (245k, pdf) Request for Health Information View Only 2012A (40k, jpg) Health Care Provider Direct Deposit Enrollment Form 2043A (162k, pdf) Program of Care for Lower Extremity Injuries Initial Assessment Report 2098A (298k, pdf) Program of Care for Lower Extremity Injuries Care & Outcomes Summary Report 2099A (426k, pdf) Health Professional Continuity Report (Form REO8) View Only 2234A (263k, pdf) Functional Abilities Form for Early and Safe Return to Work version 2006 Guide to Completing the Functional Abilities Form (239k, pdf) Old version (November 2000) of Functional Abilities Form for Timely Return to Work (187k, pdf, view only; Worker's Health number & Social Insurance number not required on form) 2647A (374k, pdf) Program of Care Occupational Asthma Screening & Initial Assessment Report 2755A (408k, pdf) Program of Care Occupational Asthma Care & Outcomes Summary Report 2756A (416k, pdf) Program of Care Occupational Asthma Reassessment Report 2757A (361k, pdf) Program of Care NIHL Rehabilitation Follow-Up Form 2825A (137k, pdf) Program of Care NIHL Assessment Summary and Treatment Plan Form 2826A (321k, pdf) Program of Care NIHL Trial Period Follow-Up Form 2827A (231k, pdf) Program of Care Occupational Contact Dermatitis Screening & Initial Assessment Report 2831A (384k, pdf) Program of Care Occupational Contact Dermatitis Reassessment Report 2832A (308k, pdf) Program of Care Occupational Contact Dermatitis Care & Outcomes Summary 2833A (347k, pdf) Early Hearing Aid Replacement Information Form 2853A (198k, pdf) Program of Care for Upper Extremity Injuries Initial Assessment Report 2864A (267K, pdf) Program of Care for Upper Extremity Injuries Care and Outcomes Summary 2856A (353k, pdf) Program of Care for Acute Low Back Injuries Initial Assessment Report 3238A (155k, pdf) Program of Care for Acute Low Back Injuries Care and Outcomes Summary 3239A (195k, pdf) Provider Payment Request for Equipment/Supplies 3941A (343k, pdf) Provider Payment Request 3947A (725k, pdf) Completing forms Download Acrobat Reader Back to Top