Healthy Lifestyle Appointments are for students motivated to make a health behaviour change, or who are interested discussing whether a change is right for you. These appointments are done by Health Promotion staff who specialize in Brief Action Planning.

DO NOT COMPLETE THIS FORM IF YOU ARE LOOKING TO BOOK AN APPOINTMENT WITH A PHYSICIAN OR COUNSELLOR. Call 613-533-2506 to book a medical or mental health appointment.

Appointments are held remotely over the phone, Microsoft Teams or Zoom.

Please fill out the form below and someone will contact you to confirm an appointment time and details. You can also email bewell@queensu.ca if you have further questions.

Contact Information

First and Last Name:

Queen's Email:

Phone number:

Can we leave a message at this phone number: Yes No

Appointment Focus

Which health behavior are you most interested in changing?

Physical activity / Exercise

Nutrition / Healthy Eating

Sleep

Self-care

Smoking: Tobacco only

Smoking: Cannabis only

Smoking: Tobacco and Cannabis

Alcohol

Appointment Scheduling

Appointments are typically 30 minutes in length and offered Monday to Friday between 9am - 4pm; accommodations can be made upon request.

Please indicate all the dates/times that work with your schedule to set up an appointment in the next 1-2 weeks. If none of these options are available, we will email you to set up an appointment time.

Monday Tuesday Wednesday Thursday Friday
9-10am
10-11am
11am-noon
Noon-1pm
1-2pm
2-3pm
3-4pm

Which type of appointment would you prefer?

Phone

Microsoft Teams

Zoom

Any of the above



8 + 8 =