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- FOI ACCESS REQUEST FORM - Bluewater Health
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Ion fee CASH CHEQUE (Payable to Bluewater Health) (Additional fees will apply per the posted Bluewater Health Fee Schedule) REQUESTER INFORMATION: LAST NAME FIRST NAME MIDDLE NAME E-MAIL ADDRESS STREET CITY or TOWN AREA TELEPHONE (DAYS) PROVINCE AREA Mrs. Ms. ADDRESS(NUMBER) Mr. Miss POSTAL CODE TELEPHONE (NIGHTS) Date or date range: Description: Preferred Method of Access to Records: ELECTRONIC PAPER EXAMINE ORIGINAL AT BLUEWATER HEALTH SIGNATURE OF REQUESTER RECEIVED:.
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