Identification of the person or organization being reported (not an OPPQ member)Last name First name Name of organization Street and number City Postal code Email Phone numberWebsite Claimant informationLast name First name Member number Street and number City Postal code Email* Phone numberRestricted activity you believe is being practiced illegallyChoose the applicable activities (select all that apply) Assessment of neuromusculoskeletal function in a person with a physical disability or impairment Functional assessment of a person when required by law Insertion of an instrument or finger into the body past the labia majora or anal verge Insertion of an instrument into the body past the pharynx or nasal vestibule Use of invasive forms of energy Wound-related treatment Decision-making on the use of restraint measures Use of needles under the skin to reduce inflammation, in addition to other means Performance of spinal and joint manipulations Title you believe is being used illegallyChoose the applicable titles (select all that apply) Physiothérapeute, pht Physiotherapist, P.T. Physical therapist Thérapeute en réadaptation physique, T.R.P. Physical rehabilitation therapist, PRT Technologue en physiothérapie, T. phys. Physiotherapy technologist, Phys. T. Why you are filing a reportBriefly summarize why you are filing a report*Evidence of Illegal PracticePlease add any relevant proof here(business card, advertisement, website, Facebook page, invoice for services, etc.) Drop files here or Select files Accepted file types: doc, docx, xls, pdf, txt, jpg, jpeg, gif, png, Max. file size: 16 MB. CommentsThis field is for validation purposes and should be left unchanged.
