Form Builder

Required fields are marked with asterisks (*)

COVID-19 Related Vaccine Order Form

If you have any questions, please send an email to vaccine@ottawa.ca.

Staff person designated to act as the contact for Ottawa Public Health for this vaccine event

Browse…

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

Your order will be delivered using your courier if you have one, otherwise we will contact you to pick up the vaccine.

Please enter clinic delivery handler/receiver contact information in the following fields:

Our current processing time is five (5) business days.



Contact Us