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Welcome

Please complete this form if you would like Public Health to contact you about sexual health services. If you need help completing this form, please call the Service First Call Centre at 519-575-4400. 



Are you 18 years old or younger?
 




What is the best way to contact you? (Check all that apply)
 


What would you like to talk to a nurse about? (Select one)
 

For internal use only:
 


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