Clinic appointment request form (immunization and tuberculosis testing)

Fields marked with a * are required.

Please use this form to request an appointment in our clinic.

Our goal is to contact you within 2 business days to provide you with an appointment date and time. You can also call us during normal business hours to make an appointment at 705.522.9200 (toll-free at 1.866.522.9200).

Your privacy

Personal information contained on this form is collected under the authority of one or more of the following (as amended): the Health Protection and Promotion Act, R.S.O. 1990; the Immunization of School Pupils Act, R.S.O.1990; the Regulated Health Professions Act, 1991, S.O. 1991; and is in compliance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 and the Personal Health Information Protection Act, 2004, S.O. 2004. This information is used to ensure that all appropriate personal care and public health services are provided, and that necessary statistics are kept. Questions about this collection should be directed to the Privacy Officer at Public Health Sudbury & Districts, 1300 Paris Street, Sudbury, ON P3E 3A3, 705.522.9200.

This item was last modified on July 4, 2017