COVID - 19 SUPPORT
Have you been tested positive for COVID -19? Punjabi Community Health Services (PCHS) can provide you with resources to help you get through this tough time. Please fill out the form below on what we can help support you with. One of our team members will be in contact with you shortly.
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Please provide your full name *
Please provide the number that we can reach you at. *
Please provide an email address that we can reach you at.
What languages are you comfortable speaking? If other, please specify.
If you are in isolation or COVID-19 positive, please select which resources you think you may need? *
Required
Do you live in L6X or L6V postal codes? *
PCHS or Queen Square FHT Staff
The next following questions are to be completed by PCHS or Queen Square FHT staff. If you are done filling out the form, you may go ahead and submit.
Intake form conducted by:
Intake through:
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Notes
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