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Health declaration

Please fill out the following form.

Date of birth
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes

Office Located in The Coven in Downtown Eau Claire

131 S Barstow St.

Suite 202 Attn: DECI
Eau Claire, WI 54701

P: 715.579.2885

E: hello@downtowneauclaire.org

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©2024 by Downtown Eau Claire, Inc. All Rights Reserved.

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