ECHO Ontario First Nations, Inuit and Métis Wellness Registration Form

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Thank you for your interest in ECHO Ontario First Nations, Inuit and Métis Wellness. Please complete the application below.

Please note: Sessions will run Wednesdays from 12:00-2:00 p.m. EST. The first six sessions will run October 30 - December 4, 2024, and the remaining six sessions will run January 8 - February 12, 2025.

The program is for Ontario-based providers who serve First Nations, Inuit and/or Métis clients/patients through Indigenous healthcare services/organizations. We also have limited space for providers who serve Indigenous clients through organizations with significant focused programming for Indigenous communities.

First Name:

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Last Name:

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Email Address:

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Phone Number:

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Extension (if applicable):

Alternative Phone Number:

Name of Organization/Agency (please avoid acronyms if possible):

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Organization/Agency Address:

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Organization/Agency City:

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Organization/Agency Postal Code:

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Which First Nations, Inuit and/or Métis communities do you serve?

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Which Ontario Health Region is your agency/organization located in?

1. North East Region - Parry Sound, Sudbury, North Bay, Timmins, Sault Ste. Marie etc.
2. North West Region - Thunder Bay, Dryden, Kenora etc.
3. East Region - Scarborough, Peterborough, Kingston, Ottawa, Hawkesbury etc.
4. Central Region - Mississauga to Huntsville, Orangeville to Markham
5. Toronto Region
6. West Region - Waterloo to Windsor, Tobermory to Niagara Falls

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Central

East

North East

North West

Toronto

West

ECHO Ontario First Nations, Inuit and Métis Wellness Registration Form

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