STEP 1: Register!

Please complete the following form so that we may learn more about you and can tailor our program to meet the needs of all our participants.

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

Personal Info

Sign in with Google







I identify as:





How much is your approximate household income? *not required


Activity Information

How much moderate to vigorous activity do you currently do each week (minutes)?


How much moderate to vigorous activity have you been doing each week for the past 6 months (minutes)?


Motivation Get More Active

My level of motivation to become more physcially active in the next 6 months is:


Improved physical health or chronic disease prevention
Improved mood/mental health
Weight Loss
Improved strength and increased muscle mass
Body image (how your body looks - beauty)
Rehabilitation from an injury
Improved posture



Barriers to Activity

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



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



Select the clinic (or Healthcare Professional) where you received you Prescription to Get Active.

Please note: The prescription is given either in the form of a tear-off-pad, a printout form or verbal instruction given to you during a virtual/phone consultation.

list of prescribers, select a match

My prescriber is not listed

Consent and Signature



First Name:

Last Name: