email Address
volunteer@atlanticpath.ca

Telephone
Halifax area 494-7284
Toll free 1-877-285-7284
Fax 1-902 494-2089

Mailing Address
The Atlantic Path
1494 Carlton St.
Halifax, NS
B3H 3B7

Dalhousie Dentistry Building
4th Floor
1581 University Ave
Halifax, NS
(Take the elevator to the 4th floor and follow the signs)

Volunteer Contact Form

*Required Field

First Name*
Last Name*
Street Address*

City*
Province*
Postal Code*	(e.g., B3H 1W5)

email*
Phone Number*	(e.g., 902 222 2222

Date of Birth*	Day Month Year

Location	Dalhousie Dentistry Building 4th Floor 1581 University Ave Halifax, NS (Take the elevator to the 4th floor and follow the signs)

Preferred Appointment Date*

How would you like to receive your Assessment Kit?*

Does your drinking water come from a well?

How did you hear about us? (optional)

Comments (optional)

	On send, a confirmation will be sent to your email address provided above.