EACR Pilot Program Provider Sign-up

Please review the Early Access Concussion Recovery (EACR) Pilot Program Service Funding Guidelines to ensure you meet the eligibility criteria before completing and submitting the application form to become an Approved Clinic within the EACR Pilot Program.

Following the submission, the applying clinic will be contacted by ICBC Recovery Programs and be required to provide a resume for each clinician referenced by the clinic in the application form.

Upon receipt of all requested information, ICBC will review the submission for a decision on whether the clinic meets the criteria to become an EACR Pilot Program Approved Clinic.

Company Profile

Principal Contact

Clinic information

Clinic Director or Operations Manager

Contact for Booking Appointments (to be shared with customers)

Please list the geographical areas in which you will provide EACR Pilot Program services.

List all clinicians that you wish to include in the EACR Pilot Program Provider list for your clinic. Ensure the providers listed meet the criteria identified in the Early Access Concussion Recovery (EACR) Pilot Program Service Funding Guidelines

Provider Name (Required) Provider Type (Required) Vendor Number
     




CL417A (032024)