Application for Copyright Clearance on Health Canada Works

The material on the Health Canada website is covered by the provisions of the 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.

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

Complete Name: (required)

Organization:

Postal Address: (required)

City/Town: (required)

Province/State: (required)

Postal/Zip Code: (required)

Country: (required)

Telephone No.: (required)

Facsimile No.:

E-Mail Address: (required)

Website Address: (recommended)

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

Individual named above

Organization named above

Other (please specify below)

3. Response

I would appreciate receiving a response by:

Month/Day/Year

4. Other

Have you previously received approval to use the same material(s)? Yes No

If yes, previous approval date. (if available)

5. Information on Health Canada's work

Title of Health Canada's work: (required)

Year/Date of publication:

Format of Source Material (required)

Paper

Internet

CD-ROM

Video/Film

Diskette

Audio tape

DVD

Other: (please specify below)

Reference Numbers

(ISBN, ISSN, Catalogue/Publication Number)

Exact URL where source material is published

Precise description of material to be used

Volume/Issue:

Table No./Figure No.

Page No(s):

Image/Photo No./Description

Additional Information

6. Applicant's reference No.

Applicant's reference No. (If you wish to assign one)

Page details

2026-07-24

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