Meet your health goals

First name*

Last name*

Date of birth

Email*

SHP or employee ID*

Employer name*

Telephone number*

Program of interest

Weight management

Healthy eating

Physical activity

Tobacco cessation

Stress management

Preferred language

Consultations are offered Monday through Friday from 9 a.m. – 6 p.m. Please include three dates and times you are available in the next two weeks.

1. Date and time:*

2. Date and time:*

3. Date and time:*

* Required field.