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Wellness Clinic
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Manage your Policy
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Manage your Policy
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Manage your Policy
Apply
Renew
FAQs
Other Modalities
Wellness Clinic
Manage your Policy
Contact
Use the following form to update your information
Name
*
First
Last
Email
*
Enter your email address. We will use this email to correspond with you.
Policy Number
*
Enter your policy number if you know it
Check each box you would like to update:
Name
Email
Address
Phone
Fax
Add Modalities
New Name
Enter both your old and new names in the appropriate fields
Name
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Suffix
New Married Name
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Suffix
Email Change
Enter your old and new email addresses in the appropriate fields below
Old Email
New Email
New Address
Enter your old and new addresses in the appropriate fields below:
Old Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
New Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
New Phone Number
Enter your old and new phone numbers in the appropriate fields below:
Old Phone
New Phone
New Fax Number
Enter your old and new fax numbers in the appropriate fields below:
Old Fax
New Fax
Checkmark any of the following modalities you practice below. We will require a copy of your training certificate/diploma or membership number.
Osteopathy
Kinesiology
Physiotherapy
Shiatsu
Animal Therapy
Hot Stone Massage (must not be web-based training)
Nutritional Consulting
Fitness Instructor
Which can you provide us with?
Membership number
Training Certificate/Diploma
Upload your training certificate/diploma
*
Drop files here or
Enter Membership Number:
*
Enter any modalities not listed above:
Comment?
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Comments
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