Request an Appointment Step 1 of 7 14% What I need help with I'm in pain or recovering from an injury I was in a car accident I have a workplace injury I need a massage I want help with movement, posture, or strength I'm looking for menopause support Something else Date of injury MM slash DD slash YYYY ICBC Claim #Date of injury MM slash DD slash YYYY WorkSafe BC Claim #Personal Health #Book Your Massage Now— or —call (250) 352-1100Book a Kinesiology Appointment Now— or —call (250) 352-1100What can we help you with? Help with daily living / recovery I'm an employer or insurer requesting an assessment Not sure / something else What can we help you with? Where does it hurt? Hand, wrist, elbow, or arm Shoulder or neck Back, hip, knee, or leg Pelvic floor Multiple areas / whole body Not sure Name(Required) First Last Email(Required) PhoneHave you been to Blackbird before? Yes No Is this for the same issue or something new? Same issue Something new Do you have a doctor's referral? Yes No Doctor's nameThere's an upload button at the bottom of this form. If you have your referral handy, feel free to upload it there. Otherwise, we'll collect it from you before your appointment.What is the nature of your concern or injury?How will you be paying?choose an optionICBC claimWorkSafe BC claimExtended health benefits (Blue Cross, Sun Life, etc.)MSP Supplementary BenefitsOut-of-pocketNot sureThis helps us prepare for your appointment. And if you have additional coverage you can let us know below.ICBC Claim #Date of accident MM slash DD slash YYYY WorkSafe Claim #Date of injury MM slash DD slash YYYY Do you have additional coverage? Yes No Preferred Days Monday Tuesday Wednesday Thursday Friday Optional. Pick as many as you wish.Preferred Time Morning Afternoon It doesn't matter Feel free to add any additional comments you may haveFile upload (optional) Drop files here or Select files Max. file size: 20 MB, Max. files: 10. You can upload any relevant files here (photos, documents, referrals). Name(Required) First Last CompanyEmail(Required) PhoneAdditional commentsFile upload (optional) Drop files here or Select files Max. file size: 20 MB, Max. files: 10. You can upload any relevant files here.
