Therapy Update
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ICBC Claims Contact
Email Address
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Confirm Email Address
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Claim Number
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Patient's Name
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A brief diagnosis of the condition as it relates to the motor vehicle accident
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Areas treating
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Number of treatments requested
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Expected discharge date
DD-MMM-YYYY
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Contact Email Address
(Enter your email address to receive a copy for your records)
Personal information provided on this form is collected pursuant to s. 26 of the Freedom of Information and Protection of Privacy Act. The personal information will be used for the purposes of claims handling.
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