Apply for Funding for Therapy Form

Last Updated: January 8, 2025

The College of Physiotherapists of Ontario maintains a program to provide financial assistance for therapy or counselling for patients who have been sexually abused by a physiotherapist. Patients who have been approved for funding for therapy and counselling can receive up to $17,370 over a five-year period. Funds are paid directly to the therapist or counsellor. The money can only be used for treatment required because of the sexual abuse by the physiotherapist. If you have any questions, please email fundingfortherapy@collegept.org.

Patient Contact Information

(Please answer as many questions as you can.)

Name of Patient(Required)

First Name of Patient Last Name of Patient

Pronoun of Patient

0 of 100 max characters

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Patient Email Address(Required)

Home Phone Number(Required)

Work Phone Number

Mobile

I was sexually abused by: (provide physiotherapist's name)(Required)

Were you a patient of the physiotherapist named above while the sexual abuse occurred?(Required)

Yes

Unsure

Has a complaint or report been made to the College of Physiotherapists of Ontario regarding this sexual abuse?(Required)

Yes

Unsure

Therapist Information

Therapist or Counsellor Contact Information (if known)

You do not need a therapist or counsellor in order to apply for funding. If you already have a therapist or counsellor, they can complete the Therapist form to submit to the College. Please note: Depending on the nature of the therapy or counselling, your request may need to be considered by the Patient Relations Committee.

Name of Provider (if known)

First Name of Provider Last Name of Provider

Pronoun of Provider

0 of 100 max characters

Provider Address

Street Address Address Line 2 City Postal Code

Provider Work Phone Number

Provider Email Address (if available)

Is this therapist/counsellor a regulated health professional?

Yes

I don’t know

If YES, please tell us what profession they are a member of:

0 of 1000 max characters

If you have more than one therapist or counsellor please provide their contact information:

0 of 2000 max characters

I intend to request reimbursement for out-of-pocket therapy or counselling costs:(Required)

Yes

I don’t know

Do you need any support or accommodation?

0 of 2000 max characters

Confirmation and Permission to Contact *required

I CONFIRM THAT:

I do not have a family or personal relationship to the Therapist or Counsellor or any other potential conflict of interest.

I understand that if I choose a Therapist or Counsellor who is not a regulated health professional they are not subject to professional discipline by the College of Physiotherapists of Ontario or any other regulatory body.

I understand that funding shall be paid only to the Therapist or Counsellor, and it shall be used only to pay for therapy or counselling for the sexual abuse that made me eligible for funding and shall not be applied directly or indirectly for any other purpose. 

I understand that the maximum amount of funding payable to any Therapist or Counsellor approved under this or any other application to the College of Physiotherapists of Ontario is the amount that the Ontario Health Insurance Plan (OHIP) would pay for 200 half-hour sessions of individual out-patient psychotherapy with a psychiatrist not to exceed $17,370.

I will use the other sources of funding for therapy or counselling that are available to me first. 

I understand that there can be no duplicate payment for the same service. To my knowledge OHIP or any other private insurer is not covering the costs associated with the therapy or counselling I receive from the Therapist or Counsellor. If at any time, OHIP or a private insurer can pay for the therapy or counselling, I shall notify the College of Physiotherapists of Ontario. 

I understand that I will need to pay for any cancellation or late fees. 

CONFIRMATION(Required)

I CONFIRM

By checking this box, I confirm the seven statements listed above and I agree to allow the College of Physiotherapists of Ontario to contact the above-named Therapist or Counsellor, as necessary, to process my application for funding.

Date(Required)

Click on the Submit Now button to send this information directly to the College of Physiotherapists of Ontario.

You can also choose to print and mail the form to:
College of Physiotherapists of Ontario
c/o Regus Business Centre,
1 Dundas Street West, Eaton Centre, Suite 2500,
Toronto, Ontario M5G 1Z3

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