Back Injury Form 

Use this Back Injury Form to give the IMaJIN physicians and Injury Care Coordinators as much information as possible about your injury.

It is valuable to get specific details of the injury, including the mechanism and timing of the injury as well as the degree of pain. A history of previous similar injuries is also important to be aware of. The physicians will want to know about any investigations or treatments that have been initiated since the injury. Finally, general information about your overall level of health, sporting involvement or work responsibilities will help the IMaJIN physicians make the best decisions regarding your injury treatment.

Our goal is to give you the best level of care possible – we appreciate the information!

Open the Back Injury Form