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Vaccine Accessibility Assessment Form

Version française

Complete this form to identify any accessibility needs during your vaccine appointment.

Are you completing this form for yourself or on behalf of someone else?
 

Appointment details

Note: some requests may need a minimum of 48 hours to accommodate supports required

Accommodations

Note: Some requests may need a minimum of 48 hours to accommodate supports required

Please select any accommodations required at the vaccination appointment
 


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