Personal Information

* Designation:








* How did you hear about us?:








* Have you previously taken Shift's Level 1 Course?



* Have you completed any additional Concussion education/training outside of Shift's program?



* Are you currently a Shift Concussion Management Member?



PRACTICE INFORMATION

Help us learn more about your practice style, setting and healthcare team.

Which healthcare disciplines currently work within your facility (select all that apply):








As part of your multidisciplinary environment, which healthcare disciplines have you utilized or recommend to your concussion patients when needed (either within your own facility or outside in your community?) (select all that apply):















Do you have a formal relationship when it comes to referrals, collaboration, inter or intra-office communication with any of the following professions (either within your own facility or outside in your community) as it pertains to concussion patients? (Ie. is there open and direct communication back and forth regarding a shared patient's rehabilitation plan)


















COURSE REGISTRATION

Which course(s) would you like to register for? (check all that apply)

* Shift Concussion Management Training: Level 2

COVID CONSIDERATIONS: Shift Concussion Management will abide by all public health guidelines/restrictions that may be in place at the time of each individual seminar. Contact us before you register if you have any specific questions or concerns regarding COVID measures. In the rare event Shift must cancel a seminar due to COVID restrictions, you will be offered a full refund or registration transfer to the online course version or another live course date where available.

CANCELLATION POLICY: If you cancel 15 days or more before the course date, you will be given the option of a full refund (less a $80.00 cancellation fee), or a transfer of your registration to our online course version where applicable. You may also be able to transfer your registration to a different live course date. If you cancel with less than 15 days notice, you will not have the option of a refund, but a transfer to the online course version can be offered where applicable.

MEMBERSHIP OPTION

For those who successfully complete all Level 2 training requirements, participants have the option of becoming a Member and Recognized Level 2 Trained Provider of the Shift Concussion Management Program. If you are already a Level 1 Member, your membership will be rolled into the Level 2 category with no added cost to you. Health Professionals interested in joining Shift's Level 2 Provider network are required to successfully pass all exams.

Membership Includes

  • Membership access to Shift's online resources, clinic forms, rehab videos, newsletters, and marketing materials
  • 50% off repeat attendance to future Shift Concussion courses
  • Access to Shift Level 2 Provider logo
  • Listing on Shift's “Find a Provider” map (highlighted as Level 2 Provider)
  • Access to Shift's Clinic Support Team
  • An ImPACT account (Immediate Post Concussion and Cognitive Testing)
  • Access to Physiotec's Shift Concussion Module for home exercise prescription (physiotec.ca) - Optional
  • Opportunity for greater involvement with Shift Concussion Management (contact us for more details)

Fees Associated with Membership

Annual Membership Fees

  • $250




Note: you will not be charged a Level 2 membership fee until you have successfully completed all Level 2 courses and exams.