Mobile Assessment Centre Request Form | North York Toronto H

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COVID-19 Vaccination: Priority Group Pre-Registration

NYGH Mobile Assessment Centre (MAC)

Facility Name

Complete if facility is 'OTHER'

Contact Name

Email

Phone

Number of Residents/Patients Requiring Testing

Number of Staff Requiring Testing

Does your facility have swabs?

Does your facility have a Public Health outbreak number?

Does your facility have a Medical Director (Physician)?

Thanks for submitting!

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