UPDATE YOUR SERVICE PROFILE



Please fill in the following information about your service. When you are finished click "Submit" at the bottom of the page. Your service will not appear immediately on the site. Champlainhealthline.ca will review the information submitted.




Service Name:
Name 1:   
Name 2:   
Name 3:   
Former Name:   
Phone Numbers: Office:   
Toll-Free:   
TTY:   
Crisis:   
After Hours:   
Fax:   
Email:   
Website:   



Mailing Information: c/o:         Street Address: (if different)
Building:   
Address:   
City:   
Province:   
Postal Code:   
Room:
Intersection:
Accessibility:
Accessibility Notes:
Hours:
Dates Available:



Executive: Name:   
Title:   
Organization:   
Phone:   
Email:   
Executive 2: Name:   
Title:   
Organization:   
Phone:   
Email:   



Public Contact: Name:   
Title:   
Organization:   
Phone:   
Email:   
Public Contact 2: Name:   
Title:   
Organization:   
Phone:   
Email:   
Service Description:
Meetings:



Funding:
Fees:
Application:
Target Population/Eligibility:
Languages:














French
Language Note:
Area(s) Served:
Year Established:
Legal Status:



Downloads:    PDF documents to be included with a service profile can be emailed to edit@champlain.ccac-ont.ca. (max. 500 kB in size)



YouTube Video #1 URL:   
Title:   
YouTube Video #2 URL:   
Title:   
YouTube Video #3 URL:   
Title:   



Categories:    This service profile appears in the following categories:
      Apartments with Supports
      Community Support Services
      Fitness, Recreational and Social Programs for Seniors
      In-Home Personal Support
      Long-Term Care Homes
      Long-Term Care Homes - Convalescent Care Beds
      Respite Care for Seniors



Please ensure that you include your name, email address and telephone number in case we need to contact you to confirm your changes.
Source: Name:  
Title:  
Organization:  
Phone:  
Email:  
Comments:



Types of Changes Submitted:

       
 



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