Clone of WRPA Active - Virtual Healthcare Program

MembersHealth is proud to partner with [union name] to provide eligible members with access to our Virtual Health and Virtual Healthcare Programs. This exclusive offering is available as part of your [union name] membership, giving you convenient, trusted access to virtual care and personalized health services. Please complete the form below to enrollment.

Name

First NameMiddle NameLast Name

Date of Birth

Date

Primary Phone Number:

Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

E-mail

example@example.com

Address

Street Address Line 2

CityProvince

Postal Code

My Products

Virtual Healthcare Treatment Annual Premium

Virtual Healthcare Program provides full clinical care with ongoing coordination and follow-up. Designed for members who want confidence, continuity, and fast access to medical professionals—without navigating the system alone.

$60.00 CAD

Enter coupon

Subtotal

Tax

Total

Payment Methods
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

My Products*

My Products