Introduction
Thank you for adding or updating your clinic’s information to Action Canada’s public and/or private directory of Sexual and Reproductive Health Service Providers.
The public directory is available 24/7 to help visitors to our website find out where they can access a variety of sexual health services, while our login-secure private directory is only accessible to our Access Line staff and volunteers who use it to support people reaching out over our Access Line from 9am-9pm EST, 7 days a week.
After submitting this form, you will be directed to a short "Accessibility Checklist”. Please fill out all criteria that applies to your clinic and feel free to reach out to our Access Line Manager, Jessa Millar at [email protected] if you have any questions or would like to discuss anything in relation to this process.
Clinic Information
Please fill out the following information as you would like it to appear on the directory.
Coverage
Questions about coverage are mandatory. Please answer "no" or "n/a" to coverage questions if they do not apply.
Services Offered
Additional options will appear for some categories of services. Select all that apply.
Agreement
I understand that for increasing access to sexual and reproductive health, the information provided above will be made public on Action Canada for Sexual Health and Rights' online sexual health hub to increase the public’s access to sexual and reproductive health services.
I understand that the above-mentioned clinic, hospital, or centre, as well as contact information, will appear on the public online directory, or only in the private directory if selected.
I understand that individual people's names and their addresses will not be made public on the directory.
I agree with the terms and conditions in this agreement, and hereby grant Action Canada for Sexual Health and Rights the right and permission to publish the information disclosed in this form regarding the services offered at said clinic, hospital, or centre. I further agree to hold harmless Action Canada for Sexual Health and Rights from and against any and all damages and claims.
Submitting this form will act as my signature.
