Register

We require the information below from participants to help inform and improve our services and to send you information about our programs and services.

For further information, contact the Prescription to Get Active (RxTGA) Program Director at 1 (866) 212-7552 Ext. 1 or send an email to alberta@prescriptiontogetactive.com.

Barriers to Activity

Are there any barriers that have stopped you from participating in physical activity previously? *not required

Yes

If yes, please select all that apply: *not required

I have nowhere convenient to be physically activeI am limited financiallyI have an injury that limits my ability to be physically activeI don't have time based on the demands and prioirties in my lifeI don't have enough knowledge on how to be physically activeI am not motivated to be more physically activeI do not have support from family, friends etc. to become physically activeI have fears around becoming physically active

Other (please specify) - Not Required

Prescription?

Do you have a prescription already?

Yes

By submitting this form, I consent to the collection of my personal information for the purposes stated above and have read and agreed to the Terms of Service