Pre-Registration for a Meet and Greet

First name*

Last name*

Phone*

Email*

City*

Of Members Wanting to Register*

Current Healthcare Information:

Where do you currently receive your healthcare? *

How did you hear about us?*

Do you want to be contacted by email or phone?*

Email

Phone

Additional Comments:

What are your top three values in life?(e.g., honesty, compassion, resilience)*

What do you look for in a healthcare provider?(Check all that apply)

Empathy

Communication

Professionalism

Holistic Approach

Availability

Other

What are your expectations from our healthcare program?

Are you willing to actively participate in your healthcare journey, including following medical advice and making lifestyle changes if necessary?*

Yes

No

How often do you expect to have appointments with your healthcare provider?*

Quarterly (every three months)

Biannually (every six months)

Annually (once a year)

Other

Full Name*

Phone*

Email*

Message*

Email*

By Appointment Only

Address: 200, 1620 29 ST NW, Calgary, AB, T2N 4L7

Phone: +1 403 371 5768

Fax: +1 403 538 6430

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