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Worksafe psychology treatment notification form 2026

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  1. Click ‘Get Form’ to open the worksafe psychology treatment notification form in the editor.
  2. Begin by filling out the 'Patient Details' section. Enter the patient's name, date of birth, claim number, and date of injury. Select the estimated duration of treatment from short term, medium term, or long term.
  3. In the 'Psychologist Details' section, provide your name and address as the treating psychologist. Include your contact information and WorkCover provider number.
  4. Complete the 'Initial Assessment' by describing the psychological condition related to the claimable injury. Ensure you detail any issues that may impede recovery.
  5. Set short-term goals in collaboration with your patient. Clearly outline these goals along with estimated time frames for achieving them.
  6. Finally, ensure both you and your patient sign and date the consent section before submitting the form.

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New York Non-Acute Pain Medical Treatment Guidelines

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