Forms Middlesex-London Health Unit 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by indicating the disease you are reporting. Check all applicable boxes, paying special attention to those marked in bold, as they require immediate reporting.
3. Specify whether the disease is confirmed or suspected by selecting the appropriate checkbox.
4. Fill in the reporting information, including the name of the clinic or hospital, your name, and phone number.
5. Complete client demographics by entering the last name, first name, date of birth, age, gender, address, city, postal code, and phone number.
6. If available, attach laboratory results and provide details such as specimen type and collection date.
7. Indicate hospitalization details if applicable: name of hospital and dates admitted or seen in emergency.
8. Lastly, provide treatment information and any additional comments as necessary.

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