Please refer to the FAQ’s when completing this form.
If you encounter problems completing/submitting this form, please email EHPRQuestions@gov.bc.ca.
Your personal information is being collected in compliance with BC privacy legislation under section 26(c) and (e) of the Freedom of Information and Protection of Privacy Act. Your information will be retained for five years and be shared with the Ministry of Health, Health Match BC and health authorities, to support B.C.’s health emergency response.
If you have any questions about our collection or use of personal information, please email your inquiries to EHPRQuestions@gov.bc.ca.