Join TidalHealth Seniors

TidalHealth Seniors is your link to information, services, programs and special events to help you enhance your health. This special program is provided as a service to our community for individuals ages 55+ who enjoy living life to the fullest.

The best part about our TidalHealth Seniors program is that it is absolutely free. There are no annual dues or fees.

Fill out the application below to join today!

Prefix

First Name *

Middle Name

Last Name *

Date of birth * +

Gender

Race

Spouse/Significant Other's Name (if applicable)

Is your spouse/significant other a TidalHealth Seniors member? 🛈

If you answered "yes" above, please provide your spouse/significant other's date of birth +

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Primary Phone Number *

Primary phone type *

Secondary Phone Number

Secondary phone type

Email Address *

How did you learn about TidalHealth Seniors?

Interests/hobbies (check all that apply)

Special needs/medical history (check all that apply)

Membership application authorization

By submitting this application:

• I authorize TidalHealth Seniors to process this application in order to receive my membership benefits upon admission to TidalHealth (i.e., visitation program).
• I authorize TidalHealth Seniors to mail the quarterly Wellness Wave newsletter and related program information to my mailing address.

• I authorize TidalHealth Seniors to send a monthly newsletter and related program information to my email address.
• I understand that if, at any time, I wish to cancel or update my membership, I will need to contact the TidalHealth Seniors membership office by phone at 410-543-7170 or in writing to:

Program Coordinator
TidalHealth Seniors
100 E. Carroll St.
Salisbury, MD 21801

Arts & crafts	Bicycling
Bowling	Cooking
Fishing	Gardening
Golf	Grandchildren
Reading	Running
Swimming	Travel
Walking	Other (please specify below) Other (please specify below)

Asthma	Cancer
Diabetes	Eye injury/disease
Heart disease	Hernia
High blood pressure	High cholesterol
Kidney disease	Leg pain
Lung disease	Mental health issues
Peptic ulcer	Rheumatism/arthritis
Other (please specify below) Other (please specify below)