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Get Travellers' Healthcare Information Form

Moment to complete the information in this form and leave a copy with your emergency contact. Be sure to also bring a copy of this form with you on your travels. Your emergency contact(s) Name (contact this person first in the event of an emergency) Address Phone number Email address Name (alternate contact) Address Phone number Email address Primary health care provider or doctor in Canada Name Address Phone number Email address Date of your last physical/checkup Travel information at y.

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