Class Sign Up - InspireHealth

Have you previously registered as a patient or support person at InspireHealth?*

Contact Information

Phone*

Contact Information

Phone*

New Patient or Support Person Information

Yes, I would like to register as a patient or support person with InspireHealth to access free supportive cancer care programs and services.

Preferred name (if different from above)

Phone*

Mobile Phone

What is your gender?*

Please name the patient you are supporting*

Please specify cancer or genetic diagnosis*

Patient Provincial Health/BC Care Card Number

Support Person Provincial Health/BC Care Card Number

Emergency Contact Phone*

This field is hidden when viewing the form

How did you hear about us?

Please specify who: (e.g. BC Cancer, Canadian Cancer Society (CCS), CCS Lodge, Doctor/Physician, Healthcare Professional, Family Member, Friend, Online Search, or Other).

This field is hidden when viewing the form

Please specify

Is there anything else you would like us to know?

This field is hidden when viewing the form

Patient Sign Up

Class Registration

Please select the week you would like to register for.
* An exercise consultation is required prior to attending any movement-based group programming.

Virtual Programming

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break - Patient Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Patient - Virtual

This field is hidden when viewing the form

End of Patient Virtual

Vancouver In-Person Programming

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break Vancouver In-Person

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break - Vancouver In-Person

This field is hidden when viewing the form

End Vancouver In Person

Victoria In-Person Programming

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break - Victoria In-Person

This field is hidden when viewing the form

Victoria In-Person

This field is hidden when viewing the form

Section Break

Kelowna In-Person Programming

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break Kelowna In-Person

This field is hidden when viewing the form

Section Break Kelowna In-Person

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Support Person Sign up

Class Registration

Please select the week you would like to register for:

Virtual Programming

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break In person - Support person

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Support Person Virtual

This field is hidden when viewing the form

Support Person Virtual

This field is hidden when viewing the form

Section Break

In-Person Programming

This field is hidden when viewing the form

Section Break - February Support In-Person

This field is hidden when viewing the form

Section Break In person - Support person

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Section Break - April Support In-Person

This field is hidden when viewing the form

Section Break In person - Support person

This field is hidden when viewing the form

Section Break

This field is hidden when viewing the form

Have you previously met with an Exercise Therapist at InspireHealth?*

This field is hidden when viewing the form

Section Break

Have you attended an exercise class at InspireHealth in the past three months?*

Exercise Therapy Assessment

Safety is our primary consideration in all programming at InspireHealth. In order for us to ensure a safe environment in movement-based group classes, all patients attending an online exercise class must have had a consultation with an InspireHealth Exercise Therapist or attended a class in the last three months. The following questions will help us understand your health and your current exercise level.

Please Specify:

What is a recent blood pressure reading (from a doctor’s office, pharmacy, etc)?*

Please specify:

This field is hidden when viewing the form

Section Break

* Please select a class to register for.

This field is hidden when viewing the form