Registration Form - Blue Health

(For those accompanying a family member or friend who is participating in the Blue Health Program)


Thank you for choosing to support your friend and family during the Blue Health Program. We look forward to partnering together on a journey to wholeness. Please note, as a secondary participant, you will get access to: all meals, lectures, and the program. But you will not get access to any discussions with the doctors, physical assessments, and lab work up. Any information shared will only be reviewed by the staff medical doctor, naturopathic doctor and nutritionist and will be kept strictly confidential.


Which session are you attending? *
Acknowledgement *
I understand that as a secondary participant, I am there to support the primary participant during the Blue Health program. I get access to all meals, and the lecture, but will not get to consult with the medical staff, will not get access to any lab work and physical assessments.
Fees
I understand that the registration fee must be paid in order to secure my spot in the program. - Blue Health North York - $80 - Blue Health Peteborough - $80
Name *
Name
Gender *
Address *
Address
Who are you accompanying? *
Who are you accompanying?
Please indicate the name of the friend/family member you are accompanying during Blue Health
Best method of contact
Please indicate any other comments you feel are necessary for us when considering your case