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Vaccine Order Form

Telephone: 613-580-6744
Completed orders may be submitted online or sent via email or fax.
Email: 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.

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)

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