Prime Care Enrollment

Wellness Event / Class / Workshop Registration

Registration for Prime Care wellness events, classes, and community workshops.

Secure enrollment form Please complete this form on a private device. Medical and enrollment information may be HIPAA-sensitive.

Attendee Information

Tell us who will attend the event or class.

First Name *

Last Name *

Phone Number *

Email Address *

ZIP Code

Choose the program type and preferred format.

Event / Class / Workshop *

Preferred Format *

In person Virtual Either

Preferred Date

Number Attending

Accessibility or Accommodation Needs