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Application for Copyright Clearance on Health Canada Works

The material on the Health Canada website is covered by the provisions of the Next link will take you to another Web site Copyright Act, by Canadian laws, policies, regulations and international agreements. Such provisions serve to identify the information source and, in specific instances, to prohibit reproduction of materials without written permission.

To submit your request for copyright permission, please complete the following form. The personal information you provide is collected to allow Health Canada to evaluate your request and to inform you of the decision. This personal information is protected under the Federal Privacy Act. Accordingly, it will be used, retained and disclosed for the purpose mentioned above only. Learn more about our commitment to privacy.

If you prefer to submit your request through mail or fax or if would like to obtain information concerning copyright ownership and restrictions on reproduction on this site, please contact:

Publishing and Copyright Officer
Distribution Centre
Marketing and Creative Services
Health Canada
70 Colombine Driveway
Basement Floor - Room 0120C
Ottawa, ON K1A 0K9
Telephone: 613-960-0625
Facsimile: 613-941-5366
E-Mail: Pubsadmin@hc-sc.gc.ca

Please note that this form applies to Health Canada works only, and that all fields marked by an asterisk (*) must be completed.

1. Applicant Information

If permission is granted, person/organization in whose name permission is to be issued

2. Information on the applicant's work

Purpose

N.B. If the Health Canada's material has been adapted or revised, copies of your adapted/revised work and Health Canada's material must be included with your request.

*Format(s) in which your work will be produced

*End Use

*Territory where your work will be distributed

3. Response

4. Other

Have you previously received approval to use the same material(s)?

5. Information on Health Canada's work

*Format of Source Material

 

OR

Precise description of material to be used

6. Applicant's reference No.