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Therapy Services Management (TSM) Registration
Congrats on joining our network, enabling you to offer Therapy Services to your clients! We're excited to have you! Please take a few minutes to fill out this form in order to expedite the process for getting you up and running.
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Business Legal Name *
Business Operating Name *
Business Type *
Facility Full Address *
Date this facility started operating *
MM
/
DD
/
YYYY
Business Email Address *
Business Phone Number *
Owner / Signing Officer Full Name *
Owner / Signing Officer Title (e.g. Owner / Co-Owner / President / Director / etc.) *
Owner / Signing Officer Mobile Number (if different from above)
Owner / Signing Officer Email address (if different from above)
Session Durations and Costs - please list durations and cost for sessions you'd like to offer (e.g. 30 min - $85, 45min - $110, 60min $130, etc).
Physiotherapist Assistants - List full name, email and phone number for each person. Please put each person in a separate line.
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