Mask Fitting Registration Mask Fitting Registration Form "*" indicates required fields Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Email* What type of test are you booking?* Qualitative Quantitative Type of mask used?* 3M N95 Mask - $50 Half Face Respirator - $80* Full Face Respirator - $80* *Mask & Filter Not IncludedDate* MM slash DD slash YYYY Time (9AM-5PM)* Hours : Minutes AM PM AM/PM Additional Information INSTRUCTIONS FOR BOOKING A FIT TEST APPOINTMENT Please read all instructions carefully before booking your appointment. Any omissions or non-compliance will result in you having to re-book the appointment at your expense. Please read the below information carefully. Some symptoms/conditions can affect your ability to be safely tested and use a respiratory mask. Please bring your puffers or necessary/emergency medication with you on the day of testing. On the day of your appointment, do not Eat, Smoke, Drink or Chew Gum 20 minutes prior to your fit test. Tests cannot be performed on individuals with FACIAL HAIR. If you cannot shave for religious or cultural reasons, please discuss it with the technician at least 24 hours before your appointment. Please arrive at your appointment 15 minutes earlier. Late arrivals may not be admitted. Failure to meet any of the above may result in a refusal to be tested and require rebooking. We do not guarantee that the first mask tried will result in a perfect fit. EACH ADDITIONAL MASK USED WILL COST $5. By clicking "submit", the individual agrees to the following: The individual fully understands the rules and procedures of the Mask Fit Testing process. That all information provided is correct. Any issues or concerns will be discussed with the technician prior to testing. Any non-compliance will result in a refusal to be tested. If you have any questions, please call (416) 635-7800Consent* I agree to the information above