We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

Name:

Mailing Address:

Telephone number:

Email address:

I support the mission, vision and values of CCHC

Yes

Please check all that apply:

I reside within 5 km of 420 Cooper Street, Centretown Community Health Centre
I work within 5 km of 420 Cooper Street, Centretown Community Health Centre
I am a student with CCHC
I am a registered volunteer with CCHC
I am an active client of one or more programs at CCHC

Note on membership dates:
Memberships accepted between June 1, 2025 and May 30, 2026 will expire on June 30, 2026.

Today's Date: