City of Orillia Health Care Provider Verification

Required fields are marked with asterisks (*)

City of Orillia Health Care Provider Verification Form

Thank you for your interest! All Health Care Providers conducting therapeutic or rehabilitative training sessions for their clients at the Orillia Recreation Centre are required to provide confirmation of their licensing as determined by the Parks and Recreation Division.

Please allow five (5) business days for someone to contact you for confirmation of the verification process.

Requirements:

Must be an accredited physiotherapist, kinesiologist, chiropractor, occupational therapist, athletic therapist, athletic therapist specialist.
A member of a recognized professional association.
Protected with a minimum $5-million liability insurance specific to the service they are providing with the Corporation of the City of Orillia named as an additional insured.
Certified in Standard First Aid and CPR – C or equivalent.

First Name

Last Name

Business Address (street number and name)

City

Province

Postal Code

Email Address

Phone number

Date of Birth (MM/DD/YYYY)

If you selected "other" or have more than 1 designation, please specify: