Chiropractic/Osteopathy/Physiotherapy Prior Financial Approval Request

This form is to be used for requesting prior financial approval to provide chiropractic, osteopathy and physiotherapy treatment to eligible veterans. Please note there are specific criteria for the approval of each treatment or service. Please see the last page of this form for these criteria.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.