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Registration request for Heart Health


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


Timeslot:
Monday 25th Jan 2027, 12:00pm - 1:00pm
Location:
Rockwood Clinic
Unit A, 175 Alma Street, Box 340 Rockwood ON Click here for map
Availability:
100 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.

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