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Registration request for Understanding Pre-Diabetes
Thank you for your interest in this event/program. Please complete and submit the form below.
Timeslot:
Tuesday 26th Jan 2027, 5:00pm - 6:00pm
Location:
Rockwood Clinic
Unit A, 175 Alma Street, Box 340 Rockwood ON
Availability:
100 spaces remaining
Full Legal Name:
Date of Birth:
Email:
Confirm email:
Phone Number:
Are you enrolled with one of our physicians?
Select...
Other or non-FHT provider
Dr Saif Ahmad
Dr Blair Cappel
Dr Lucille Chan
Dr Laura Daly
Dr Sahar Ghorayeb
Dr Nupur Gupta
Dr Karina Hilferink
Dr Anam Irshad
Dr Rabia Khan
Dr Alejandra Marin
Dr Nancie Parent
Dr Preksha Shukla
How did you hear about this program?
Select...
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Email from EWFHT
EWFHT Clinic
EWFHT Staff (specify below)
EWFHT Website
Facebook
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School
Other (specify below)
Message:
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