The Dr. Goodenowe ALS Challenge

Full Name*

First NameLast Name

E-mail Address*

example@example.com

Contact Number

Are you a Moose Jaw Resident?*

YesNo

Select any conditions that apply:

Please share more details on your diagnosis or main health complaint (optional)

Are you a provider and would like to learn more about the programs?

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Disclaimer: The Moose Jaw Vitality Project does not replace conventional medical care. Individual results may vary. No guarantees or assurances of specific outcomes are made or implied. Participation is voluntary, and offered at no cost to eligible Moose Jaw residents.