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Beauty And Body Art

Notice Of Personal Services Setting Form

This form is to be completed by the owner or operator and forwarded to the Medical Officer of Health at least 14 days prior to opening, adding new services or renovating an existing PSS. If you are currently operating, you are required to complete this form and forward to the Medical Officer of Health by October 31, 2018.

Download form here that can be mailed to: 

Simcoe Muskoka District Health Unit
Clinical Service Department
15 Sperling Drive
Barrie, ON L4M 6K9


 

 

Select choices



Premises Physical Description

Is the Operator information the same as the Owner information listed above?
Do you rent/lease out any space within the premises listed above to another PSS operator?

Operational Information


If seasonal, list months above

Services (Check all that apply)

Aesthetics






Body Modification






Medical Aesthetics



Personal information on this form is collected under the authority of the Health Protection and Promotion Act, 1990 and Ontario Regulation 136/1
The information will be used to maintain an inventory and to conduct investigations related to Infection Prevention and Control. Documents are maintained pursuant to the Municipal Freedom of Information and Protection of Privacy Act, 1991 and the Personal Health Information Protection Act, 2004.  Questions regarding the collection, use and disclosure of personal information should be directed to the Office of the Privacy Officer, Simcoe Muskoka District Health Unit, 15 Sperling Drive, Barrie ON L4M 6K9, (705) 721-7520 or 1-877-721-7520. 
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