Please enter your name and email address below. After pressing the Submit button you will be sent to an online form. This form is 5-pages long and contains the following two documents:
1. A medical information form
2. A waiver.
Please fill out and electronically sign both of them. Fields with a red border are mandatory. If the “Confirm Signature” box does not pop up when you have completed the forms, it means there is information missing from a mandatory field that needs to be completed before you can continue.
Your confidential medical information will be stored in a secure place. If you’d like more information about the security system we use, you can find it here.