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Wellness Clinic
Manage your Policy
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Manage your Policy

Home » Manage your Policy

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
Prefix First Last Suffix
New Married Name
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 Province Postal Code
New Address
Street Address Address Line 2 City 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?
Leave us any additional comments.
Email
This field is for validation purposes and should be left unchanged.

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