Verification Form - Ontario - cicb gov on 2025

1. Click ‘Get Form’ to open the Verification Form in the editor.
2. Begin by entering your CICB File Number at the top of the form. This is essential for tracking your claim.
3. Next, fill in the Claimant Name field with your full name as it appears on your application.
4. In the Treatment Provider’s Name section, input the name of your treatment provider who will be submitting invoices.
5. Ensure that the Treatment Provider’s Signature is included; this confirms their authorization for payment.
6. For each treatment session, record the Treatment Date and Type of Treatment. Be sure to include the number of minutes per session.
7. Finally, have the Claimant sign at the end of each treatment session to validate that services were received.

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