Required fields are marked with asterisks (*)

Physical Activity Group Intake Form

For all programs, groups and services at Grand River Community Health Centre, we collect information about our group participants and clients. The info collected on this form will also help us to provide you with the best experience possible at GRCHC. 

Please note, for physical activity groups we require emergency info from all clients. 

Social Information 

Some social information is collected to help us better understand client needs and to improve our programs. If there is a question you would rather not answer, we provide a "prefer not to answer" option!