Please complete all sections. We will contact you by phone within one business day to schedule your appointment or to review your case.
Thank you for your interest in IOHS. We look forward to caring for your occupational therapy needs!
Is the client medically cleared to return to work?
Is the client’s pre-injury employment available?
If not, is alternate employment available?
SERVICE:(Please select only one.)
For a brief explanation of each, hold your mouse over that service.
For more detailed information, click on the name to open that page in a new
window. To complete this form, simply close that new window once you have
finished reading it.
1. Functional Capacity Evaluation
2. Targeted Functional Assessment
3. Job Match
4. Functional Back Evaluations
5. Pre-employment Screening
6. Case Management
7. Job Site Analysis
8. Ergonomic Workstation Review
9. Ergonomic Risk Analysis/Adjudication Assessment
10. Home Demands Analysis
11. Clinic Based Occupational Rehabilitation
12. Worksite Occupational Rehabilitation
13. Enhanced Fitness Program
14. Education/Ergonomic Consultation
15. Back Injury Prevention Program
16. Functional Hand Assessment and Customized Splints
17. Foot Assessment and Customized Orthotics
18. Progressive Goal Attainment Program (PGAP)
19. Mental Health Return to Work Services
20. Medical-Legal Consultation
21. Future Cost of Care Assessment
22. Other (describe service requested)
Thank you. By completing this form, you have allowed us to process your request as quickly as possible.
Please click the "Submit" button below, and remember when you come to your initial appoint, to please bring with you all recent medical documentation.
27 AUSTIN STREET • ST. JOHN'S • NL • CANADA • A1B 4C3
709•722•9675 • Fax 709•722•9677 • firstname.lastname@example.org