Southwest IPAC Hub
Please complete this form to join our Southwest IPAC email group to receive updates and information.
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Name:
Email:
Comment:
Facility Name / Organization
*
If your facility has no name, please enter the address as Name of Facility.
Email Address
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First Name
Please enter a contact name.
Last Name
Type of Facility
Long Term Care Home
Retirement Home
Shelter
Supportive Housing
Hospice
Assisted Living
Other Congregate Living
Other Organization Type
Location: Check All That Apply
St. Thomas, Elgin County or Oxford County
Middlesex County or the City of London
Huron or Perth County
None of the above
Ministry Affiliation(s)
MCCSS
MMAH
CYMH
CHO
CHPI
MOH
MLTC
EDU
SOLGEN
MSAA
PRIVATE
NONE
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