Accessible Service Form | Hastings Prince Edward Public Health

Accessible Service Form

E.g., 2017-11-24
E.g., 01:25PM
Type of Assistance Required
Please list the type(s) of mobility aid required
Please list the types of communication / assistive devices required
Please list the types of communication / assistive devices required
Assistant Accommodations
Contact Information

We will ensure that your needs are addressed when you visit, and we may contact you in advance of your visit to discuss further. Thank you for taking the time to fill out this form.