CAERS Covid Vaccine Injury Intake Form

Thanks you for considering applying for Vaccine Injury Treatment from CC TeleHealth. We have been working closely with CAERS to improve the well being of individuals harmed through taking the COVID-19 Vaccine.

Vaccine Injury Treatment is Available in the Following Canadian Provinces:

  • BC
  • Alberta
  • Saskatchewan
  • Ontario
  • New Brunswick
  • Nova Scotia


Option One

  • $399 + $50 CC TeleHealth Lifetime Membership Fee
    (designed for members on a restricted budget)
  • This is a one step at a time plan. Each session finishes with a follow-up activity to discuss the next step and a choice by member for what to do next.

Treatment Price Includes the Following Appointments
  • One 1-hour appointment with a Health Care Practitioner (HCP), with prescriptions as deemed appropriate and one follow-up appointment with a Registered Nurse (RN) to document progress and select next step. During these treatment sessions the following is accomplished.

  • Completion of assessment forms by member to provide background information to the HCP.
  • A review of the assessment forms by the HCP to develop an appropriate plan of action for member Vaccine Injury treatment;
  • Identification of critical care that may be urgently needed, along with a referral for treatment, if necessary

  • One 1-hour appointment/assessment visit with HCP
  • A multi-week, phase one treatment set of prescriptions will be provided (generally for up to 1-3 months)

Registered Nurse Support Activities
  • One 30-minute follow-up appointment with a Registered Nurse to monitor progress;
  • RNs provide feedback, support and answers to health questions to support the member’s healing process;
  • Scheduling for the next step with HCP.

Financial Details
  • Initial payment of $100. to schedule appointment ($50 membership + $50 deposit towards the balance of the appointment fee)
  • Balance due after the first appointment

Treatment Choices
  • Member has choice to continue with “pay as you go” and choose next appointment or to choose the “OPTION TWO” Package (Switch from $399 to $799 package) with a total of 2 more HCP visits and 2-3 nurse follow-up visits.

Option Two

  • $799 + $50 CCTH Membership Fee
    (Designed for members who would like a broader range of treatment to track results and adjust treatment according to member progress during treatment)
  • The first phase of treatment is customized to your needs and provides progressive feedback on whether the commonly effective treatments work for you. This treatment package provides an assessment of health conditions, treatment with medications that are somewhat likely to show improvement over a 3-6 month period. After this first phase package, next steps will be recommended based on outcomes experienced in Phase One. This package of services includes:
Health Assessment
  • Completion of a series of assessment forms by member (nutritional, metabolic, health history, diet etc);
  • Review of forms by a Health Care Provider (HCP) to develop an appropriate plan of action for member;
  • Identification of critical care that may be urgently needed, along with a referral for treatment if necessary.

  • Three appointments with a HCP, provided over a period of 3-6 months;
  • HCP visits are designed to provide and adjust treatments based on how a member is responding to treatments;
  • Response to treatments in phase one provide a road-map on what may be required for phase two.

Registered Nurse (RN) Support Activities
  • Two or three visits with a Registered Nurse to monitor progress and provide health care support;
  • RN visits are to identify changes, and provide guidance in member activities that support the healing process;
  • Providing feedback, support and answers to health questions.

Participation Within a Support Community (optional)
  • Access to support group activities (6 weeks), providing guidance and support with respect to adjusting lifestyle activities to better cope with COVID-19 Vaccine Injury;
  • A  support community that reduces the stress and loneliness experienced from the isolation due to Vaccine Injury:  provides a place to talk with others who are in a similar situation;
  • A Guided Community: the activities and topics covered in the support community are designed to enhance lifestyle practices that affect the healing process. Areas addressed in the Guided Community are:
    • skills for belonging and connecting within a community. (Support community is facilitated by practice experts, including guidance on how to participate in a community in a manner that encourages and strengthens each member’s coping abilities);
    • relationships:
      • relationships with family and friends;
      • relationships with the medical system;
      • relationship with yourself;
    • intermittent fasting;
    • sleep;
    • food;
    • dealing with stress and fear;
    • building your support community;
    • managing and tracking symptoms;
    • mourning the loss caused by health challenges.
  • Treatment package includes a book called, Covid Vaccine Adverse Reaction Survival Guide, by Caroline Pover.

Financial Details
  • Initial payment: $100 to schedule appointment ($50 membership + $50 deposit towards the balance of your appointment fee).
  • Balance due after your first appointment.

<span “=””>Assessment Forms

The following forms will need to be completed, and will be used as part of your intake process:

  1. CAERS COVID-19 VACCINE INJURY INTAKE FORM: providing us with history of general health, COVID-19 history and Post Vaccine Injury;
  2. INFORMED CONSENT:  providing clarification of the science and practices we utilize, and your agreement to be treated based on our approach to science and developing treatment practices;
  3. COVID-19 VACCINE INJURY CONDITIONS ASSESSMENT TOOL: used for assessing the severity of health conditions you are experiencing;
  4. 2-DAY NUTRITIONAL TRACKING FORM:  Designed to track your diet and how it could be affecting your health.

* Please recognize that the more we know about you, the better we are able to help.