Important: this signup page is only for referring healthcare providers. For standard reservation with $15 contribution, please sign up on the main page. (The small fee goes towards helping us rent the room, maintain the site, print flyers, etc.)

Name *

First Name

Last Name

Email *

Contact info only used in case we need to reach you about cancelations/inlcement weather, etc.

Phone *

(###)

###

####

Workshop date *

The workshop is the first Thursday of the following months, availability may vary.

February

April

June

August

October

December

What is your medical specialty? *

How did you learn about the workshop?

Flyer

Website

Friend

Provider

Other

Thank you! You will hear back from us with confirmation shortly. Please contact us if you do not hear back within 1 week's time, or if you have any questions: info@drjoelsclinic.com. See you soon!

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Trailhead Pediatrics, 5231 NE Martin Luther King Jr Blvd, Portland OR 97211503-342-2180info@trailheadpediatrics.com