1 Current: Page 1 2 Page 2 3 Preview Identification Enter your name as it appears on your PEI Health Card. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Preferred Method of Contact - Select -EmailTelephone Preferred Email Address Preferred Telephone Number Date of Birth Select or type dates as MM-DD-YYYY. For example 02-13-1971 Personal Health Number (PHN) Please enter the 8-digits from your PEI health card. Requested Testing Site Preferred Clinic Location - Select -Charlottetown - Park StreetSlemon Park Preferred Clinic Date Review the hours of operation for each clinic prior to requesting an appointment Preferred Clinic Time Period - Select -8:00-12:001:00-3:30