Required fields are marked with asterisks (*)

Personal Service Settings Notification Form

Owners and operators of personal service settings in Durham Region must provide written notification to Durham Region Health Department 14 days before:

opening a new personal service setting;
changing the location of an existing personal service setting;
starting the renovation or reconstruction of an existing personal service setting; or,
providing additional services in an existing personal service setting.

Notification

Please indicate the type of notificiation you are making:

Opening a new personal service setting

Address change of an existing personal service setting

Reconstruction or renovation of an existing personal service setting

New services being offered at an existing personal service setting

Contact information

Business/Operating Name

First Name

Last Name

Business Address

City

Postal Code

Phone Number

Email Address

Please provide any additional information, comments or questions below.

Information is collected under the authority of the Health Protection and Promotion Act, R.S.O. 1990, cH.7., s.5 (as amended). This information is collected and used for the purpose of preventing, eliminating and/or decreasing the effects of a health hazard. Questions about this collection of information should be addressed to Durham Region Health Department, Manager, Health Information, Privacy and Security at 605 Rossland Rd E., P.O. Box 730, Whitby, ON L1N 0B2, (905) 668-7711.

DUHEV-541