Program Registration

Please fill out this form if you are interested in the Integrative Yoga Therapy program at St. Elizabeth’s hospital.   This will not commit you to a program.  Someone will be in touch with you shortly.

PROGRAM FEES:
For the eight (8) week session, the fee is $120 payable by check to St. Elizabeth’s M.S. Center.  We do not accept credit cards.  For those who need financial assistance, there might be limited funds available.  Payment is expected at the first session.

Your Name (required)

Your Email (required)

When did you contract MS?

How ambulatory are you?
 No physical disability Mild to moderate gait impairment when not using an assistive device Mild to moderate gait improvement when using an assistive device More severe impairment, but ambulatory, when using an assistive device Severe impairment and confined to a wheelchair

What times are good for you?
 10:30 AM to Noon 1:30 PM to 3:00 PM 4:30 PM to 6:00 PM 6:00 PM to 7:30 PM

What days are good for you?
 Monday Tuesday Wednesday Thursday Friday Saturday

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