Screening Program Prize Entry Form

Thank you for participating in the Mental Health & Substance Use Screening Program.
Submit this ballot for a chance to win a prize; the Grand Prize will be a $100 Grocery Card!

Limited time offer; open to Newfoundland & Labrador residents only.

*All information provided will be kept confidential and is NOT linked to screening results.

1. Please provide your contact information:

First Name

Last Name

Email Address

Phone Number

City/Town

2. How did you find out about the Mental Health & Substance Use Screening Program?

Please enter an 'other' value for this selection.