Program Calendar Program Intake

Program Intake Form

Thank you for expressing interest in a Thames Valley Family Health Team program. Please note that completing this form does not register you for a specific date and time. We will add you to the next available program based on travel preferences. You will be contacted within one to two weeks with confirmation of details.
  • Information left may include program name, date, time, and/or location.
  • Please select the location of your family physician's office from the list below.
  • This field is for validation purposes and should be left unchanged.

Your health information is treated with respect and we work hard to protect your privacy and the security of the information you provide. Access to the information you have provided is available only to those who need to know because they are involved in referring you or coordinating, delivering, or evaluating the resources associated with group programming.  We will not share this information outside of our organization without your permission.