Menu


Registration request for Understanding & Managing Your Diabetes - 2 Sessions


Thank you for your interest in this event/program. Please complete and submit the form below.


Timeslot:
Tuesday 24th Sep 2019, 10:00am - 12:00pm
Location:
Rockwood Clinic
Unit A, 175 Alma Street, Box 340 Rockwood ON Click here for map
Availability:
10 spaces remaining



Full Legal Name:
 
Date of Birth:
Email:
Confirm email:
 
Phone Number:
 
Are you enrolled with one of our physicians?
How did you hear about this program?
Message:
 
By clicking "Submit", you agree to send this personal information to East Wellington Family Health Team online.

You agree to the Privacy Policy, which governs how your personal information is kept safe.