Personal information collected from this form is done so in accordance with provincial privacy legislation and is used for the administration of public health programs and statistical purposes only. For information about the collection of information, contact:
Brant: Freedom of Information Coordinator, Brant County Health Unit 519-753-4937 ext. 222FOI@bchu.org
Haldimand-Norfolk: Katherine Bristol, Records Management / FOI Coordinator 519-426-5870 ext. 1261 email@example.com
If you would like assistance completing this form or to receive this form in a different format, please contact Brant County Health Unit at 519-753-4937.
194 Terrace Hill St.,