Form Builder

Required fields are marked with asterisks (*)

Reportable Infectious Diseases and Events Reporting Form

Patient Information

Disease Information


Allowed extensions pdf, jpg, jpeg, gif, png, tif

Treatment History

Is STI treatment information available at reporting time?

Physician Information


Personal information on this form is collected under the authority of the Health Protection and Promotion Act, Sections 22 and 24, and will be used for public health follow-up. Any questions should be directed to the Infectious Disease Program at 613-580-2424, ext. 24224.

Contact Us