Vouch Form

Note: You must be signed-in before completing this form.

Name*
First Last
Email*
Full Membership in Vision Therapy Canada (VTC) means you are offering your patients, complete full-scope, one on one, in-office VT. Stand-alone and/or home-assigned VT related, including computer activities do not qualify.
Please select from the list below, a VTC Full member colleague who can vouch for you.*
- I acknowledge that I offer complete in-office Vision Therapy and Rehabilitation.
- I acknowledge that I offer home-based only as adjunct treatment and not as stand-alone therapy.
- I acknowledge that I may be subject to random audit to ensure my compliance with the above statements.
- I acknowledge that applicants/members/vouching members found to be fraudulent will have their membership revoked.
- I acknowledge that the membership fee is non-refundable.
*
- I acknowledge all of the above.
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