SRHR Map: Request Changes to an Existing Service
Instructions
We appreciate you taking the time to fill out our form and correct or update an existing service entry. The more information you can provide, the better our resource will be. We appreciate your help in keeping our information current and up to date. All change requests are reviewed by our team before going live on the public database. In most cases simple changes will be made within a few days. However, if we need to verify your authority to request changes or have any questions, we will be in touch at the email address you provided on the form.
Your Name
First Name
Last Name
Your Phone Number
Your E-mail
example@example.com
What is your connection to this service?
Service user
Employee
Owner/Operator
Volunteer
Other
Service Name
*
The name of the service that you wish to request changes to on SRHR Map. For example, Planned Parenthood, or Jones Community Health Centre.
Changes Requested
Please be detailed and include any relevant information that must be updated. For example, if you are requesting an address change please include the complete address, or if a new program has been added to your service include all necessary details.
If you have any additional notes about this service, please include them here.
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Submit
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