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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

ATTENTIONAll information below must be completed clearly. Please indicate doses on hand when placing a Vaccine order.

For current processing times, please refer to our website Ottawa Public Health.

Please submit your monthly temperature log when placing a Vaccine Order. 

For age and high-risk criteria, please refer to the Publicly Funded Immunization Schedules for Ontario-June 2022.

Send me a confirmation email for this request.
 
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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)



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