Level 1 Introductory Course Registration

Join our network of highly trained Healthcare Providers and stay up-to-date on the latest research developments and practice guidelines in the concussion management space. In addition to a practice listing on our website, qualifying Practitioners receive access to our resource library, discounted courses, free webinars, practice support, research articles, newsletters, affiliate/supplier discounts, and more!

Check out our learning platform to preview some of the exclusive content offered.

Click here to view our Membership Brochure for more information on how to become a Shift Concussion Management Provider. Note that practitioners must successfully complete both the Level 1 and Level 2 course streams in order to qualify.

When you’re ready to join, simply complete the Membership Application and a Shift Representative will review your eligibility and contact you!

Personal Information

* First Name: * Last Name: * Email:

Phone # (Mobile): Phone # (Business):

Clinic Location 1

* Clinic Name: * Clinic Address: * City:

* Province/State: * Country: * Postal/ZIP Code:

Clinic Location 2

Clinic Name: Clinic Address: City:

Province/State: Country: Postal/ZIP Code:

* Designation:

Physiotherapist
Chiropractor
Occupational Therapist
Physician
Physician's Assistant
Nurse Practicioner
Osteopathic Manual Practitioner
Other

*Although we recognize that it takes a broad team of health disciplines to adequately address the complexities of persistent concussion cases, our membership is geared best to primary contact clinical medical-rehab professionals. If your health discipline does not appear in the above list, leave a note in the "other" section and one of our representatives will be in contact with you to determine your eligibility.

* When did you complete Shift's Level 1 course "Best Practices in Concussion Management?"

Year (Please Specify)

Year (Please Specify):

I have not completed this course

* When did you complete Shift's Level 2 course stream?

Year (Please Specify)

Year (Please Specify):

I have not completed this course

PRACTICE INFORMATION

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

* How many Concussion cases do you typically see in a month?:

* In what type of clinic is your practice based?

Private-Solo Practice
Private-Multidisciplinary (2 disciplines)
Private-Multidisciplinary (>2 disciplines)
Public-Inpatient
Public-Outpatient
Other

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

Just Me (Solo Practice)
Physiotherapist
Chiropractor
Athletic Therapist
Occupational Therapist
Osteopathic Manual Practitioner

Massage Therapist
Registered Kinesiologist
Physician (MD)
Naturopath
Other

* 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):

Physiotherapist
Chiropractor
Optometrist
Athletic Therapist
Occupational Therapist
Osteopathic Manual Practitioner
Massage Therapist
Naturopath
Psychologist

Psychotherapist
Neuropsychologist
Audiologist
Speech and Language Pathologist
Social Worker
Medical Specialties (eg. Neurologist, Ophthalmologist, Psychiatrist, Physiatrist)
Other

Comments :

* 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)

Physiotherapist
Chiropractor
Optometrist
Athletic Therapist
Occupational Therapist
Osteopathic Manual Practitioner
Massage Therapist
Naturopath
Psychologist

Psychotherapist
Neuropsychologist
Audiologist
Speech and Language Pathologist
Social Worker
Medical Specialties (eg. Neurologist, Ophthalmologist, Psychiatrist, Physiatrist)
Other

Comments :

* What is the duration of your initial concussion assessment appointment (in terms of direct contact with the patient)?:

* What is the duration of your follow-up post-injury patient visits (on average)?:

* Do you have access to a gym space/rehab space in order to complete exercises/exertion testing and training for your patients (as discussed at Shift's introductory course)?:

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

Yes
No