Register for the My e-coaching program

Would you like to join the e-coaching program at La Tour hospital? Fill out our form below and we will get back to you as soon as possible.

"My e-coaching" plan

Your details

First name*

Last name*

Date of birth (dd / mm / yyyy)*

Telephone number *

Email*

Address*

E-coaching and you

What is your goal through this program?*

What is your current level of physical fitness?*

How did you find out about the program?*

En nous transmettant vos informations via ce formulaire vous consentez à ce que vos données de santé soient utilisées par nos équipes médicales et administratives pour répondre à votre demande. Pour plus d'informations veuillez consulter notre politique de confidentialité