Menu


Registration request for The Highs & Lows of Diabetes


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


Timeslot:
Sunday 12th Dec 2027, 7:00pm - 7:00pm
Location:
FHT Office



Full Legal Name:
 
Date of Birth:
Email:
Confirm email:
 
Phone Number:
 
Are you enrolled with one of our physicians?
I would prefer to attend virtually (Zoom):
I would prefer to attend In Person:
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.