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WorkSafeBC Form 83D667: Chiropractic Treatment Report

Chiropractors treating workers with WorkSafeBC claims use this three-page report for three purposes: a musculoskeletal extension request (83D664), a concussion/vestibular intake report (83D662) or a concussion/vestibular extension request (83D663). It records return-to-work status, subjective and objective findings, concussion screening where relevant, functional abilities, and the treatment goals, plan and sessions requested.

Who completes it

The treating chiropractor completes the report, with their name and payee number as required fields, and confirms whether it was discussed with the worker.

Submitting and payment

How to submit it
Upload the completed form through WorkSafeBC's online claims uploader, as the form instructs; WorkSafeBC's chiropractor information also points to My Provider Services.
Who pays
Fields marked with an asterisk are required for WorkSafeBC to process payment, and for extension requests the date of service on the invoice must match the report.

Good to know

  • MSK extension requests are due by the sixth week or eighth visit, whichever comes first, or 7 days before the end of an extension period.
  • The concussion/vestibular intake report is due within 7 calendar days of the initial visit, with the intake assessment date as the date of service.
  • Concussion/vestibular extension requests are due no later than 7 calendar days before the treatment period ends and no earlier than its third calendar week.
  • For the concussion/vestibular stream, comment on loss of consciousness, memory loss, altered mental state and neurological deficit, plus vestibular screen and balance findings.

Get the official form

Download the current version from the source each time; forms change without notice.

Chiropractic Treatment Report (Form 83D667)

Official page

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Frequently asked questions

When is the WorkSafeBC chiropractic extension request due?

For musculoskeletal care, by the sixth week or eighth visit of the initial treatment period, whichever comes first, or 7 days before the end of an extension period. Concussion/vestibular extensions are due no later than 7 calendar days before the treatment period ends and no earlier than its third calendar week.

Do chiropractors need approval for concussion treatment under WorkSafeBC?

Yes. Concussion/vestibular treatment needs WorkSafeBC approval before it begins, even on accepted claims. The intake report (83D662) on this form is due within 7 calendar days of the initial visit, with the intake assessment date as the date of service.