Pembroke - Access Request Form

Access Request Form

Request for Access to Personal Health Information

Third Party Access Request Form

Request for Audit of Consent Directive Activity

Phone: (613) 732-8770, extension 8005

Toll Free: 1-800-991-7711

Fax: (613) 735-8238

If you or someone you know is experiencing a mental health crisis, please call our 24/7 Mental Health Crisis Line 1-866-996-0991

705 Mackay Street
Pembroke, Ontario
K8A 1G8

Phone: (613) 732-2811

Release of Information office:

Requesting Medical Chart/Information

(613) 732-2811, extension 6142

(613) 732-6343 Fax

Emergency Department Fax:

(613) 732-6351

Fracture Clinic Fax:

(613) 633-4578

Lab Fax:

(613) 732-6353