This form will allow a member of our staff to call or text you at a convenient time to provide more information about our coaching programsYour information request will be kept on file for one week or until we can contact you by phone (whichever occurs sooner).*



* A designated staff member for Consortia Care may collect personal health information by phone or SMS text message, according to the requirements specified in the Health Information Act of Alberta, sections 27(1)(a),(g).