{"id":1493,"date":"2025-05-14T09:30:32","date_gmt":"2025-05-14T09:30:32","guid":{"rendered":"https:\/\/softwavetherapycanada.com\/arc\/?page_id=1493"},"modified":"2025-06-19T12:52:34","modified_gmt":"2025-06-19T12:52:34","slug":"motor-vehicle-accident","status":"publish","type":"page","link":"https:\/\/softwavetherapycanada.com\/arc\/motor-vehicle-accident\/","title":{"rendered":"Motor Vehicle Accident:"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1493\" class=\"elementor elementor-1493\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-216ba9c e-flex e-con-boxed e-con e-parent\" data-id=\"216ba9c\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-25a8cc4 elementor-widget elementor-widget-heading\" data-id=\"25a8cc4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"> Motor Vehicle Accident:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1087c0c e-flex e-con-boxed e-con e-parent\" data-id=\"1087c0c\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-aae8723 e-flex e-con-boxed e-con e-child\" data-id=\"aae8723\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-37beb41 elementor-widget elementor-widget-heading\" data-id=\"37beb41\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">New<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b612de3 elementor-widget elementor-widget-heading\" data-id=\"b612de3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Intake<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a3fd3f0 elementor-widget elementor-widget-heading\" data-id=\"a3fd3f0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">If you prefer to fill out the forms by hand, you can download the PDF version and bring it in on your appointment day.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b0aaf56 contact-form elementor-widget elementor-widget-shortcode\" data-id=\"b0aaf56\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1498-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1498\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/arc\/wp-json\/wp\/v2\/pages\/1493#wpcf7-f1498-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1498\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1498-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"container mva-intake-form\">\n  <div class=\"row\">\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Birth (DD\/MM\/YYYY)\" value=\"\" type=\"text\" name=\"date-of-birth\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Gender\" value=\"\" type=\"text\" name=\"gender\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Phone\" value=\"\" type=\"text\" name=\"phone\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"Email\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Address\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"City\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"province\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Province\" value=\"\" type=\"text\" name=\"province\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Postal Code\" value=\"\" type=\"text\" name=\"postal-code\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"accident-description\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Brief description of the accident\" name=\"accident-description\"><\/textarea><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"accident-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Date of Accident (DD\/MM\/YYYY)\" value=\"\" type=\"text\" name=\"accident-date\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"accident-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Time of Accident\" value=\"\" type=\"text\" name=\"accident-time\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"accident-location\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Accident Location (Intersection, Highway, etc.)\" name=\"accident-location\"><\/textarea><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"symptoms\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Symptoms you are currently experiencing\" name=\"symptoms\"><\/textarea><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"current-family-doctor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Current Family Doctor\" value=\"\" type=\"text\" name=\"current-family-doctor\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"clinic-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Clinic Name\" value=\"\" type=\"text\" name=\"clinic-name\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"past-injuries\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Have you had any past injuries or conditions that may affect your recovery?\" name=\"past-injuries\"><\/textarea><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"insurance-company\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Insurance Company\" value=\"\" type=\"text\" name=\"insurance-company\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"claim-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Claim Number\" value=\"\" type=\"text\" name=\"claim-number\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"adjuster-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Adjuster Name\" value=\"\" type=\"text\" name=\"adjuster-name\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"adjuster-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Adjuster Phone\" value=\"\" type=\"text\" name=\"adjuster-phone\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"adjuster-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"Adjuster Email\" value=\"\" type=\"email\" name=\"adjuster-email\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"lawyer-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Lawyer Name (if applicable)\" value=\"\" type=\"text\" name=\"lawyer-name\" \/><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"lawyer-contact\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Lawyer Contact Info\" name=\"lawyer-contact\"><\/textarea><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <h4>Preferred Contact Method<\/h4>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"contact-method\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"contact-method[]\" value=\"Phone\" \/><span class=\"wpcf7-list-item-label\">Phone<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"contact-method[]\" value=\"Email\" \/><span class=\"wpcf7-list-item-label\">Email<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"contact-method[]\" value=\"Either\" \/><span class=\"wpcf7-list-item-label\">Either<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n\n    <div class=\"col-md-12\">\n      <h4>Agreement<\/h4>\n      I confirm that the information I have provided in regards to my current condition and past health history are to the best of my knowledge. I also acknowledge that it is my responsibility to update the clinic in regards to any changes in my health condition.\n\nI authorize my insurance benefits be paid directly to the clinic. I acknowledge that any treatment fees not covered by MVA will be my responsibility, and I understand that I am financially responsible for any balance. I authorize Active Rehab Centre or insurance company to release any information required to process my claims. \n\nI also authorize Active Rehab Centre to release information regarding my medical condition to my family physician.\n<br><br>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"agreement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"agreement\" value=\"Agree\" \/><span class=\"wpcf7-list-item-label\">Agree<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"agreement\" value=\"Disagree\" \/><span class=\"wpcf7-list-item-label\">Disagree<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n\n    <div class=\"btn-fomr mb-3\">\n    <input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-default\" type=\"submit\" value=\"Submit\" \/>\n  <\/div>\n  <\/div>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a490b6d e-con-full e-flex e-con e-parent\" data-id=\"a490b6d\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0eb2cfc elementor-widget elementor-widget-html\" data-id=\"0eb2cfc\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<iframe src=\"https:\/\/www.google.com\/maps\/embed?pb=!1m18!1m12!1m3!1d2528.2634840022547!2d-79.27715062381674!3d43.77555807109661!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x89d4d19bebda1ddd%3A0xc1c4cca0249bf38e!2s2240%20Midland%20Ave%2C%20Scarborough%2C%20ON%20M1P%204R9%2C%20Canada!5e1!3m2!1sen!2s!4v1747122853705!5m2!1sen!2s\" width=\"600\" height=\"450\" style=\"border:0;\" allowfullscreen=\"\" loading=\"lazy\" referrerpolicy=\"no-referrer-when-downgrade\"><\/iframe>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-51cb397 e-flex e-con-boxed e-con e-parent\" data-id=\"51cb397\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-9afec90 e-con-full e-flex e-con e-child\" data-id=\"9afec90\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b5dc4a3 elementor-widget elementor-widget-heading\" data-id=\"b5dc4a3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Didn\u2019t find the answers you were looking for?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9698f7b elementor-widget elementor-widget-heading\" data-id=\"9698f7b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Just get in touch with us with your preferred method! We will try our best to help you with any and all questions.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1ada86d e-con-full e-flex e-con e-child\" data-id=\"1ada86d\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3edc205 elementor-align-center btn-default wow fadeInUp elementor-widget elementor-widget-button\" data-id=\"3edc205\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/softwavetherapycanada.com\/arc\/contact-us\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact Us<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Motor Vehicle Accident: New Patient Intake If you prefer to fill out the forms by hand, you can download the PDF version and bring it in on your appointment day. Didn\u2019t find the answers you were looking for? Just get in touch with us with your preferred method! We will try our best to help [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1493","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/comments?post=1493"}],"version-history":[{"count":0,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1493\/revisions"}],"wp:attachment":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/media?parent=1493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}