Please provide the following information to cancel your booked appointment at a WDGPH clinic. Please note if you have booked your appointment at a pharmacy you must contact them directly to cancel. First name * Last Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Phone Number * Email Address Date of Appointment * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Personal information is collected under the authority of s. 5(2) of the Health Protection and Promotion Act. This information will be used for the control of disease and the provision of immunization services, in compliance with legal and regulatory requirements. Any questions about the collection of personal information should be addressed to the Chief Privacy Officer, 160 Chancellor’s Way, Guelph ON, N1G 0E1, 1-800-265-7293 ext. 2975, privacy@wdgpublichealth.ca
