How To Register

If you or a loved one is living with a life-limiting or end of life illness, you can self-refer to Every Day Counts. Thanks to community support from donors, this program is free of charge. No doctor’s referral is required. Every Day Counts is open to all people living on the North Shore plus their support circle of family and friends.

Not sure if EDC is the right support for you? Please read our FAQ, or contact us to learn more.

We are a collaborative care practice focusing on wellness and support. We do not offer primary care or medical treatments.

  • Step 1: Read the above information and check out our FAQ page
  • Step 2: Fill out the registration application below. If you are filling the form out for someone else, please use their personal contact information. The fields marked with an asterisk (*) are required.
  • Step 3: Our Intake Coordinator will contact you within one week by phone to set up a call to discuss the program and your application, and answer any questions. This registration call generally takes 15 minutes and is completed over the phone.
  • Personal Information

  • MM slash DD slash YYYY
  • Contact Information

  • Emergency Contact Information

  • Medical Information

  • Other Information

  • Assumption of Risk and Release of and Waiver of Liability Indemnity Agreement

    Please sign the waiver below. You are urged to consult with your family doctor prior to participating in programs/events offered by Every Day Counts.
  • Release and Indemnification

    Every Day Counts will make available the opportunity of participating in activities and programs; this activity/programs may present various elements of risk. Accidents resulting from such activities may occur and may cause injury. The participants assume the risk associated with the activity.
  • I understand and accept the above and provide Every Day Counts with the following waiver of liability and indemnification agreement.
  • I hereby release Every Day Counts and its staff and agents from any and all liability unless caused by Every Day Counts negligence for any injury sustained by me, resulting from my participation in the activity arranged through Every Day Counts. This document shall only be considered an acknowledgement of risk and will not absolve Every Day Counts of negligence arising out of their operations.
  • I hereby agree to keep private all information shared with me by my peers in the group and/or volunteers of Every Day Counts, at all times. I understand that privacy and confidentiality for all Every Day Counts participants is required by law. Exceptions are only made in circumstances where there is imminent threat of harm to self or another, or suspected abuse of a vulnerable person.
  • Privacy

    Every Day Counts is committed to protecting the privacy of our participants. The information collected on this form will be used for the purposes of administering your group participation, including issuing notices and for statistical purposes. The information will also be used to send you information about Every Day Counts (e.g. newsletters, upcoming workshops, program updates). Your information will not be sold, rented or bartered to any other organization. You may withdraw consent for future use of your information at any time by contacting [email protected].
  • This field is for validation purposes and should be left unchanged.