Public Health Agency of Canada
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This form applies for Health Canada and the Public Health Agency of Canada requests only. Please note that all fields with an asterisk (*) are mandatory.
N.B. If the material has been adapted or revised, copies of your adapted/revised work and Public Health Agency of Canada's material must be included with your request.
I would appreciate receiving a response by:
(If you wish to assign one)
If you need assistance in completing this form, please contact the Publishing and Copyright Administrative Officer listed below. Please address all correspondence to:
Publishing and Copyright Administrative Officer
Public Affairs Directorate
Brooke Claxton Building, Basement, Room 0120C
Ottawa ON K1A 0K9