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Spring 2023- Walking to Wellness
Co-hosted by Canadian Mental Health Association and On the Ground Counselling Inc. and supported by the City of Prince George and various community supporters. .
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Name
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Your answer
Address
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Your answer
email (we will send confirmation and info to this email and information how to pay for your registration)
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Your answer
Best phone number and time of day to reach you at?
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Your answer
Emergency contact person while you are at the clinic -(their name and number please)
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Your answer
T-shirts
T-shirts -you may order a women's or mens t-shirt. Links are here: ladieshttps://
media.sanmarcanada.com/pdfs/ATC_L3517.pdf
menshttps://
media.sanmarcanada.com/pdfs/ATC_S3517.pdf
(color will be the same for everyone)
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Your answer
Pick women's or men's-shirt
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Womens
Mens
Required
T-Shirt size
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XS
S
M
L
XL
XXL
Family doctor name and number
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Your answer
Are there any other health professionals you are working with?
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Your answer
Care card number
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Your answer
What do you hope this walking group will help you achieve in terms of your mental health?
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Your answer
Are there specific strategies you'd like to learn more about or practice during the clinic?
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Your answer
Do you have any physical health conditions or concerns you'd like to share with clinic organizers?
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Your answer
How would you describe your current state of mental wellness?
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Your answer
Would you like a personal phone call from one of our walk leaders before the clinic to ask questions?
Maybe
Yes
No
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Are you able to comfortably walk for 20 minutes at an easy pace?
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Your answer
Do you have any medical conditions (non mental health) you are currently seeing a doctor for? (example high blood pressure, diabetes, heart condition, etc)
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Your answer
Do you have any other worries that you'd like to share with us? How can we best support YOU??? This information is very helpful for our planning purposes to create an experience that will help you.
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Your answer
For safety purposes, closed toed athletic style footwear is required. We have a good supply of gently used athletic shoes if you require them. If you do, please let us know your size and we'll do our best to find you some!!
Your answer
How did you find out about the clinic?
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If your medical coverage includes the services of a Registered Clinical Counsellor, your fees may possibly be claimed on extended health. Does this apply to you?
Yes
No
Maybe
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