To register as a client of Country Roads,  we need information about you and your health needs.  We want to make this as easy as we can for you.

  1. If you have a computer and a printer, you can print the forms at home, complete them and bring them to our office in Westport or Portland.
  2. If you prefer to pick up a paper copy, we have them available for you at either office.
  3. If you would like us to mail you the registration forms, please call 613-272-3302 extension 261 or email

Registration for Health Services

Health Questionnaire

Consent For The Release Of Health Info


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