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?


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)


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

* Shift Concussion Management Training: Level 2

Note: Practitioners wishing to become a recognized Level 2 Provider of Shift's Program MUST complete both “Vestibular and Ocular Rehabilitation for Concussion” AND Complex Case Management with Cervical Treatment Considerations” in their entirety. Contact us for more information on course agendas.


* Select Registration Category


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 ( - 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.