Spencer Health Employee Activation Form

Activation Number*

If you are unsure of your activation number, please contact our office at 416-512-1616.
Start Date*
YYYY dash MM dash DD
Name*
First Last
Additional Family Members:

*If you are entering multiple names, please separate them by commas.*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Phone
This field is for validation purposes and should be left unchanged.