Initial attending physician statement - 12900E01 - Desjardins Life 2026

1. Click ‘Get Form’ to open the Initial Attending Physician Statement in the editor.
2. Begin with Part 1, where the patient must provide their identification details including first and last names, date of birth, address, and contact information.
3. In Part 2, the physician will complete their statement. They should start by detailing the diagnosis, including any complications and subjective symptoms.
4. Next, the physician should document the patient's medical history, including dates of symptom onset and treatment history. Ensure all relevant clinical notes are attached.
5. Continue filling out sections regarding treatment plans, progress assessments, and return-to-work plans. Each section requires specific details about medications and rehabilitation options.
6. Finally, ensure that both patient and physician sign off on the form before submitting it to Desjardins Financial Security Life Assurance Company.

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