After-Call Information Request Form

After-call information request form

2069 Battersea Road Glenburnie, ON. K0H 1S0

Phone: 613 548-9400

If you or a relation were treated and transported by Frontenac Paramedics and you have questions related to that specific call, please complete this form. A representative will return your enquiry shortly.

Patient's full name(Required)

First Last

Date of the call(Required)

Approximate time of the call

Are you enquiring on behalf of a patient who isn't you?

Yes

Your first and last name(Required)

First Last

Your telephone number

Your email address

Please describe your enquiry? What would you like ask about this call?(Required)