Consent Form for Residents of Long Term Care Facilities

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Authorization Form

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Authorization for Treatment and Payment Information

We would appreciate if you could update the billing information for Next of Kin, and notify us when there is a change of address for Next of Kin. Payments can be made by preauthorized cheque, credit card, and invoice. We also accept cash at the time of treatment. You could also make arrangements with the health care facility to pay for treatment from the resident’s Comfort Account.

If you have any questions, please ask to speak with the Chiropodist when he visits the Home or call 416-763-9199