🌱 Reconnecting with your Roots: Registration Form
✨ Thank you for being here!
To make the process smoother, we've created this registration form so you can easily sign up for our upcoming group.
Please note: you won't be charged throughout this registration 💛
Once you fill out this form, we’ll get back to you via email within 3 working days to confirm all the details, save your spot and guide you through the next steps.
Please include:
✔️ Name (first, last, and preferred if different)
✔️Pronouns
✔️Birth Date
✔️Phone Number
Thank you!
This is an in-person group, so we want to make sure you'll be able to attend 💛
We will use this email to contact you. Please make sure the spelling is correct 💛
If you do not have insurance, please choose "No".
Please note: We offer direct billing with select insurance providers (you can find the list on the group’s webpage). If your provider isn’t on the list, you may still be able to submit receipts manually for reimbursement through your insurance. Our office coordinator will be happy to assist you once we receive your form.
If you do not have insurance, please indicate that in the box below and "Submit".
We’ll get back to you via email within 3 business days (usually within a day) to confirm all the details, save your spot and guide you through the next steps.
If you have any questions or would like to clarify anything about the group, feel free to email us at info@thecognitivecorner.ca