Vaccine Order Form

 

 

Telephone: 613-580-6744
Completed orders may be submitted online or sent via email or fax.
Email: vaccine@ottawa.ca Fax: 613-580-2783

ATTENTION: All information below must be completed clearly. Please indicate doses on hand when placing a Vaccine Order.

Please submit your monthly temperature log when placing a Vaccine Order. Please allow 7 working days to process your order.

For age and high-risk criteria, please refer to the Publicly Funded Immunization Schedules for Ontario-December 2016.

 

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Check off the vaccines you would like to order
Check off the vaccines you would like to order (Note: The following vaccines must be pre-authorized)

Additional supplies you would like to order (select all that apply)