Aging in Community Contact Form

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Please complete the contact form below so that we can be in touch as we seek to better understand the challenges currently faced by older adults and the types of services that they would need to feel secure and comfortable in their home in the years to come.

For more information please contact JH Partners at info@jhpartners.net or by phone at 418-684-5333, ext. 11835.

First Name *

Family Name *

Phone Number

Email Address

Postal Code *

Preferred method of communication

Phone

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I consent to the Wellness Centre, co-managed by Jeffery Hale Community Partners, staying in touch with me. I understand that I can cancel my consent later at any time. *

Yes

Your age category *

55-64

65-74

75-84

85+

Please check all that apply

I am helping someone in our community as they grow older.

I want to grow older in my own home as long as possible.

Are there any activities related to health and wellness you would like us to offer? Any comments to share?

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