Insight Disability Tax Credit Assessment – Intake & Payment (Step 1)

Insight Disability Solutions

Disability Tax Credit Assessment – Intake & Payment (Step 1)
Insight Disability Solution

Disability Tax Credit Assessment: Intake & Payment
Welcome to Insight Disability Solutions!

Please complete this form and pay the assessment fee to enroll in our program. By submitting this form and paying, you agree to the assessment fee and non-refundable policy. After payment, our team will contact you to schedule your mandatory secure video consultation with a certified assessor / Nurse Practitioner (NP). Document uploads and additional forms will be provided following your consult.

Insight Disability Solutions provides a private, fee-based functional assessment to determine whether an individual may meet eligibility criteria for the Canada Revenue Agency (CRA) Disability Tax Credit (DTC).

Submission of this form initiates a professional assessment request. Payment covers intake review and the mandatory NP consultation only and does not guarantee CRA approval.

Receipts & Tax Information

Upon successful payment, you will receive an electronic receipt for your records.

Where permitted by the Canada Revenue Agency (CRA), fees paid for assessments provided by a licensed medical practitioner may be eligible to be claimed as a medical expense on your personal income tax return (CRA lines 33099 or 33199). Eligibility is determined by the CRA. Insight Disability Solutions does not provide tax advice and clients are encouraged to confirm eligibility with the CRA or a qualified tax professional.

Electronic receipts are automatically issued to the email address provided at the time of payment. Clients are responsible for ensuring their contact information is accurate and for retaining their receipt for tax purposes. If a receipt needs to be re-sent, clients may request a copy by contacting our office. Identity verification may be required. Administrative fees may apply for repeated requests.

Privacy & Collection of Personal Health Information

By completing this form, you consent to the collection, use, and secure storage of your personal and health information for the purpose of clinical assessment, documentation support, and communication related to Disability Tax Credit services.

Information is collected and stored using secure electronic systems with privacy protections in place. Access is limited to authorized members of the Insight Disability Solutions team involved in your assessment.

Your information will not be shared with third parties except when requested with permission, as required to provide services, meet professional obligations, or comply with applicable laws.

If you have questions about privacy or data handling, please contact our office before submitting this form.
Confimation to proceed:*

I understand and wish to proceed with a Disability Tax Credit assessment through Insight Disability Solutions.
Client Demographics
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of birth*

MonthDayYear
Date
Assessment Fee & Refund Policy

The assessment fee covers professional intake review, document analysis, and preparation for a mandatory secure video consultation.

Once this form is submitted and payment is processed, the assessment process begins and fees are non-refundable.

Submission of this form does not guarantee approval of the Disability Tax Credit by the Canada Revenue Agency.

This fee represents a professional intake review, functional assessment, and Nurse Practitioner consultation.

Where permitted by the Canada Revenue Agency, this assessment fee may be claimed as a medical expense under eligible medical practitioner services.

Payment does not guarantee approval of the Disability Tax Credit.
Acknowledgement & Consent (Required)*

I understand that the assessment fee is non-refundable once this form is submitted and the assessment process has begun. I acknowledge that I have read and agree to the Assessment Fee & Non-Refundable Policy and Terms of Service. I understand that payment does not guarantee approval of the Disability Tax Credit by the Canada Revenue Agency (CRA).I understand that upon submission of this form and successful payment, Insight Disability Solutions will receive confirmation of my intake and payment. I acknowledge that a member of the Insight Disability Solutions team will contact me within 3–4 business days (excluding weekends and statutory holidays) to confirm next steps and arrange the required secure consultation.I confirm that I am a resident of Ontario or Nova Scotia, Canada and understand that this service is virtual only. I understand that if I am outside these provinces or require in-person care, I am not eligible and fees are non-refundable.
Payment*
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Disability Tax Credit Assessment Fee
$275.00CAD Quantity

Total

$0.00CAD
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Insight Disability Solutions

Insight Disability Solution

Client Demographics