Public Health Alert - Registration

PUBLIC HEALTH ALERT - REGISTRATION

* Indicates required field

* First name

* Last name

* Type of Organization/Facility

* Name of Organization/Facility

* Profession/Role

If Other, please explain

* Email address

* Confirm Email address

Street Number

Street Name

Unit #

If applicable

City

Postal Code

Format: L4M 6K9

Phone number

Format: xxx-xxx-xxxx

Phone Type

Cellular
Landline

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Type the code from the image

The Health Unit collects personal information in the course of doing business. Personal information about you is collected directly from you or from the person acting on your behalf. Personal health information collected may include, for example, your name, date of birth, address, contact information, health card number, health history, and information you provide during visits or calls to the health unit.