Insurance Application
Only available to current members in Canada
1.
Full Name:
Address:
City:
Province:
Postal Code:
Home Phone:
Work Phone:
Mobile Phone:
Email::
Website:
Business Type:
Sole Propietorship
Partnership
Incorporated
2.
Business Name:
Yes
No
Do you have any employees?
3.
Receptionist, etc.
Number of non-professiona staff:
Number of professional staff:
Must have own Professional Malpractice coverage
Yes
No
4.
Are you a student?
Please select the modalities that you would like to be covered.
5.
Modality 1:
Reflexology
Modality 2:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Up to 5 modalities can be covered at no additional cost. Remember that you must be qualified for the covered modality.
Modality 3:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Modality 4:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Modality 5:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Modalities marked with " * " will have a 25% surcharge applied due to the higher risk by the modality.
Modality 6:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Modality 7:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
For addditional modalities more than 5, there is a cost of $40 for each additional modality.
Modality 8:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Modality 9:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Download the list of modalities available for coverage (pdf).
Modality 10:
Select ...
Access Bars™
Access Consciousness
Access Healing Body Work
Acupressure
Acupressure Therapy
Akashic Records
Alexander Technique
Algotherapy
Anat Baniel Method™
Antigynastique™
Aqua Chi
Aqua Fitness Instruction
Aquamassage / Hydrotherapy
Aquatic Exercise Therapy
Aromatherapy
Art Therapy
Ashton Patterning
Ask and Receive
Aura Soma Color Healing
Axiatonal Alignment
Bach Flower Remedy
Balneotherapy
Bamboo Fusion Massage
BEST
Behavioral Analysis
Bi-Aura Therapy
Bio Cell Therapy
Bio Energetics
Bio Feedback
Body Mind Balancing
Body Talk System
Body Work
Bowen Technique
Brain Gym™
Brandon Raynor Massage
Breathwork
Breema
Brine Baths
Certified First Aid
Chakra Balancing
Chi Ni Tsang
Coaching
Color Therapy
Craniosacral Therapy
Crystal Healing
Cupping Therapy (Air/Suction cup only – no fire/bleeding)
Dance Movement Therapy
Deep Muscle Therapy
Deep Oscillation Therapy
Ear Coning/Candling*
Eden Energy
Elecro Therapy
EMF Balancing Technique
Emotional Freedom Technique
Energetic Healing
Energy Therapy
Energy Work / Balancing
Ergonomic Therapy
Facial Massage
Feldenkrais Method
Feng Shui
Grasten Technique™
Guided Imagery
Health Coaching
Health Centered Therapy
Heart Wisdom Connection™
Hellerwork
Herbalism
Holistic Counseling
Horticultural Therapy
Hot Stone Massage
Indian Head Massage
Indonesian Massage
Integrated Energy Therapy (IET)
Intervention (RDI) ™
Intolerance Elimination
Ion Foot Bath/Massage/Cleanse/Soak
Ion Therapy including Ion foot Massage
Iridology
Jin Shin Life Work Coaching
Journey Practitioner™
Kinesiology
Lomi-Lomi
Magnetic Therapy (PEMF)
Manual Lymph Drainage
Martial Arts Instructor Fitness (No contact)*
Massage Therapy
Meditation
Meridian Stress Assessment
Muscle Activation Techniques
Music-Thanatology
Myofascial Release Technique
Natural Face Lift Technique
Nerve Stimulation (TENS/IFC)
Neuro Linguistic Therapy
Neuro Muscular Therapy
Neurofeedback
NeuroOptimal™/ Zengar
Nutrition Therapy
Peat Therapy
Pediatric Sleep Consultant
Personal Fitness Instructor*
Physiotherapist Aide*
Pilates / PiYo Instructor*
Plexus Bio
Polarity Therapy
Pranic Healing
Pregnancy Massage
Qi Gong
Quantum Touch
Raindrop Therapy
Raviv Method
Recreational Therapist
Reflexology Therapy
Registered Holistic Nutrition Consultant
Reiki / Master Sotai
Rejuvenating Face Massage
Relationship Development Intervention (RDI)™
Relaxation Massage
Relaxation Therapy Rolfing
Relaxation/Chair Massage
Rosen Method
Rubenfeld Synergy
Seniors Fitness Instructor*
Shamanic Healing
Shiatsu
Somato Emotion Release
Sound Therapy / Healing
Spiritual Counselor
Spiritual Therapy/Direction
Structural Integration
Swedish Massage
Tai Chi / Tai Chi Instructor*
Thai Massage
Thalassotherapy
Thanadoula/Contemplative
The Radiance Technique
Therapeutic Touch
Total Body Modification
Touch for Health
Trager Approach
Trigenics
Yamana Body Rolling
Yoga (not Hot Yoga)
Yoga Assistant/Instructor*
Zero Balancing
Yes
No
6.
In the past, has the Applicant or any of his/her employees ever been the recipient of any allegations of professioinal negligence in writing or verbally?
No
Yes
7.
Has any insurer ever declined, cancelled or imposed special conditions for any coverage, for you or your entity in the past?
Yes
No
8.
Is the Applicant or any of his/her employees aware of any facts, circumstances, or situations which may reasonably give rise to a claim, other than advised above?
If "YES" to any of questions 6-8, please provide full detials in the box below:
Yes
No
I understand that my OCR membership must be current at the time of this application and maintained throughout the year.
9.
You must be a current member in good standing. Unfortunately, we cannot process your application.
Now
Specific Date
Start Date of Insurance Coverage:
10.
Please select Starting Date:
Important Notice:
1. Coverage cannot be bound unless this application form has been fully completed. The undersigned has the power to complete and execute this Application Form, on behalf of all persons proposed for this insurance and declares that, after inquiry, the statements set forth herein, together with all materials and information submitted or requested by the Insurer, is true.
2. Although the signing of this Application Form does not bind the undersigned nor the Insurer to effect insurance, it is agreed that this Application Form and its attachments shall be the basis of the contract should a policy be issued and shall be deemed to be attached to and form part of the policy. The Insurer is hereby authorized to make any investigation and inquiry in connection with this application that it deems necessary. If the information in this Application Form materially changes prior to the Effective Date of this policy, the Insured will immediately notify the Insurer in writing and the Insurer may effect changes in, or withdraw, the quotation.
3. It is understood and agreed that if knowledge of any such facts, circumstances or situations exists, whether or not disclosed, any claim or action subsequently arising or developing therefrom shall be excluded from coverage.
4. Coverage is not bound until your payment is approved. Prices subject to change without notice.
Disclosure and Consent:
As part of my application for insurance I consent to the collection and use of personal information required for purposes of considering my application for errors and omissions insurance by the authorized insurance broker, Prolink Ltd and PROLINK Insurance Group Inc. The insurer and the broker are authorized to collect, use, and disclose personal information and provide such personal information to third parties, as required for the purpose of underwriting this application for insurance, as permitted by the relevant provincial and federal privacy laws or other applicable laws. The privacy policy can be viewed at the website www.prolink.insure
I understand that at any time I may ask to review the personal information pertaining to my application for insurance and the broker will be obligated to provide me with any information I am entitled to receive under the relevant provincial and federal privacy laws or other applicable laws.
I HEREBY DECLARE that the above statements and particulars are true to the best of my knowledge, that I have not suppressed or misstated any facts and I agree that this application shall form part of the insurance policy. I also acknowledge that I am obligated to report any changes that could affect the disclosures in this application that occur after the date of signature, but prior to the effective date of coverage.
I have read and understand the terms of this insurance application:
Please type your name, signifying that you accept the terms of this application: