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COVID-19 Related Vaccine Order Form

Please use this survey to request the vaccines once the approval has been granted by OPH. If you have any questions, please send an email to

This form needs to be filled in at least 48 hours before clinic operation to ensure proper dose allocation and timely deliveries.

As part of the current efforts to reach increased coverage targets in the province to protect individuals and the population, it is important to take every opportunity to vaccinate, especially for those who may be vaccine hesitant and for those who may be less likely to return for their vaccine, either first or second doses. Therefore, opening a vial to vaccinate one or a small number of individuals will be necessary to support vaccination efforts and reaching provincial targets. Efforts should continue to be made in these instances to locate other potential individuals for vaccination wherever possible. Please make every effort to minimize wastage of vaccine.
If you have questions about vaccine wastage, contact OPH’s Mobile Immunization Team by email at

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