Please complete this following form ONCE (per person) to confirm your interest in participating in the screening.
Please complete all questions until you get to the screen saying "COMPLETE"
By clicking the "NEXT" button below, you consent to booking your appointment via email. Please contact us at 613-696-7071 if you do not want to schedule your appointment via email.
*All information received will be kept confidential in the Prevention and Wellness Centre and will only be used for the purposes of registration.
