Physiotherapy Referral Pad

Want to win a job like this?
This customer received 26 stationery designs from 6 designers. They chose this stationery design from Akshar Shailesh as the winning design.
Join for free Find Design JobsStationery Design Brief
-Need a referral pad for physiotherapy to be provided to doctors' offices. I would like it to be simple, not too cluttered and sharp looking so doctors can quickly complete it for clients.
-I have attached my logo which I would like to include. I have also included my business cards to keep the style, font, colors etc consistent.
-I would like to include my slogan
From Our Home To Yours
-I would like it to include services options with tick boxes for Mobile, Clinic, Telehealth, YWCHSB
-I would like for it to say Call to Book or Book Online
-I would like it to include my clinic address:
158 Sybil Circle
Whitehorse, YT
Y1A0R6
-I would like it to include my contact info:
Brad Holm BSc(kin), MPT, CAFCI, IMS
(867)336-7176
physio@holmtherapy.ca
-I would like lines for the following:
Patient Name:
Diagnosis/Recommendations:
(extra lines to fill out patient info)
Physician Signature
Date
Target Market(s)
Physicians to refer clients to physiotherapy
Industry/Entity Type
Physical Therapy
Requirements
Must have
- Clean, concise, easy to look at and find pertinant categories for physicians
Nice to have
- Holm Therapy color scheme. Please see business cards and website as needed
Should not have
- Not too cluttered or wordy