Prospect2 -

STROKESTRA® Pre-Registration

Thank you for your interest in participating in STROKESTRA®. Please join our waitlist below to be notified about future programming.

First Name *

Last Name *

Email *

Phone *

I am a: *

Strokestra - Program Preference

Option 1: For survivors who are 3-6 months post-stroke and caregivers

Option 2: For survivors 6 months-1 year post stroke and caregivers

Option 3: For survivors who are more than 1 year post stroke and caregivers

Do you have any mobility/accessibility requirements you would like us to be aware of?

How Did You Hear About Us? *

Word of Mouth

Flyer

Website

Social Media

Referral

If you were referred from an organization or support group, please indicate below:

By providing your phone number you consent to receive text messages from Dr. Phillips Center at the number provided, including messages sent by autodialer. Msg & data rates may apply.

Please verify your request. *