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Use your name as written on your Manitoba Health Services Card.
Use your name as written on your Manitoba Health Services Card.


Manitoba Health Card

Birthdate
Birthdate
Address
Address
We may need to contact you to clarify information you have provided. Please provide your email and phone number below.
We may need to contact you to clarify information you have provided. Please provide your email and phone number below.
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We will mail you a copy of your Pap test results within 1-2 weeks. The information you provide in this form will only be used to send your Pap test results. If you have questions, please contact your healthcare provider or CervixCheck.