Try for free

WorkSafeNB Chiropractic Form 8-10

New Brunswick chiropractors use this two-page form both for the First Chiropractic Report of Accident or Occupational Disease and for progress reports. Page 1 goes to WorkSafeNB with the clinical report, diagnosis, recommendations, treatment plan and billing lines. Page 2 has clinical information removed under the Personal Health Information Privacy and Access Act and goes to the patient to give their employer.

Who completes it

The chiropractor completes and signs both pages, confirming they believe the injury or illness is consistent with the workplace accident or exposure and attesting to the information's accuracy. The worker separately applies for benefits and the employer files its own report of injury.

Submitting and payment

How to submit it
Submit page 1 within 72 hours of the appointment through MyServices secure email, by toll-free fax or by mail; if you email or fax it, don't mail the original. Give page 2 to the patient for their employer.
Who pays
WorkSafeNB pays through the billing lines on page 1 (date of service, description, fee and payee number), and the form states that payment depends on legible completion.

Good to know

  • The employer note rates the worker able or unable to bend, climb, kneel, lift, sit, stand, walk or drive, and is valid for up to 14 days without further review.
  • For a progress report, rate subjective and objective progress as improved, unchanged or regressed, and attach any applicable clinic notes or charts.
  • Flag concussion or mTBI with altered mental state, amnesia, focal defect or loss of consciousness, and note complicating factors and recommendations such as specialist, physio, OT assessment or imaging.
  • Timely reports are a legislative requirement and a standard in WorkSafeNB's agreement with the New Brunswick Chiropractors Association.

Get the official form

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

Chiropractic Form 8-10

Formulaire 8-10 – Rapport du chiropraticien

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When is WorkSafeNB Chiropractic Form 8-10 due?

WorkSafeNB says physician, nurse practitioner and chiropractor reports are due within 72 hours of the injured worker's appointment. Timely reporting is both a legislative requirement and a standard in WorkSafeNB's agreement with the New Brunswick Chiropractors Association, and it helps workers receive appropriate care when they need it.

What does the employer see from Form 8-10?

Only page 2, the patient and employer copy. Clinical information is removed under New Brunswick's Personal Health Information Privacy and Access Act, leaving worker details, the visit date and the functional abilities note: able to do usual duties, able or unable to do listed tasks, or case management to call for detail.

Is Chiropractic Form 8-10 available in French?

Yes. WorkSafeNB publishes Formulaire 8-10, Rapport du chiropraticien, on its French-language site, travailsecuritairenb.ca. Physicians and nurse practitioners in New Brunswick use a separate Medical Form 8-10 rather than the chiropractic version.