Switch to:

Neighborhood Care Event Registration Form

Switch to:

Registration Form

{class_name}

{class_date} | {class_time} - {class_time_end}

First Name*

Last Name*

Email Address*

Phone Number

Home Zip Code*

Are you an EmblemHealth member?

Do you have a language preference other than English?*

If yes, what is your language preference?

Please share any questions you would like to have answered during class.

*Indicates a required field By clicking this box, I am acknowledging that I have voluntarily elected to partake in the services provided by Neighborhood Care, owned and operated by EmblemHealth Services Company, LLC (“EmblemHealth”). I understand that this information is for general educational purposes only and is in no way a tailored or personalized treatment plan or treatment recommendation as neither Neighborhood Care nor EmblemHealth diagnose conditions, or provide treatment advice. I understand that I should seek prior consultation and approval from a licensed physician or the appropriate health care provider before acting on any information received. Additionally, I understand and forever release EmblemHealth, its affiliates and employees from and against any and all demands or claims whatsoever, that I or my heirs have, or hereafter may have against the EmblemHealth, arising out of my attendance or participation in any of the educational/informative sessions or activities offered at Neighborhood Care. This waiver and release of claims is without limitation, and includes a waiver against any act or omission of any agent, employee, licensee or invitee of EmblemHealth. *

By clicking this box, I am attesting that I have read this Acknowledgement Waiver and General Release, and that I understand and agree to be legally bound by its terms. *

I agree to receive e-mail communications regarding information about the class or event I am registering for. *

I understand that the phone number I provided on this form may be used by EmblemHealth or any of its contracted parties to contact me about my account, my health benefit plan or related programs, or services provided to me. *

I would like to receive updates and information about classes and events from EmblemHealth.

Find a doctor or medical office

broker

myEmblemHealth Member Portal

Language Assistance:

Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.

Neighborhood Care Event Registration Form

Search

Popular Tasks

Neighborhood Care

Registration Form

{class_name}

Find a doctor or medical office

Find a doctor or medical office

myEmblemHealth Member Portal

Language Assistance:

Neighborhood Care Event Registration Form

Popular Tasks

Neighborhood Care

Registration Form

{class_name}

ALSO OF INTEREST

Find a doctor or medical office

Find a doctor or medical office

myEmblemHealth Member Portal

Language Assistance: