Form Builder

Required fields are marked with asterisks (*)

Influenza Vaccine Order Form 2022-2023

*Your fridge temperature recordings must be included for this order to be processed

Delivery Information

Please allow 2-3 business days for process and delivery.
If you are using Dynacare (registered participants only) or Bio-Test, you can expect automatic delivery of your order.
If you are using Self-pick up or On-Demand Courier, you will receive a phone call when your order is ready. Please arrange to retrieve your order within 48hrs of notification.
Please bring a cooler and ice packs when picking up vaccine.
Vaccine Program hours are Monday to Friday, 8:00am to 4:00pm.

Questions and comments regarding your order may be directed to: vaccine@ottawa.ca or 613-580-6744

Please complete all fields:

Physician/Institution/Agency Name:

Contact Name:

Office Address:

Office Telephone:

Fax Number:

E-mail Address:

Please select the vaccine(s) you would like to order:

FluLaval Tetra® (QIV) or Fluzone Quad® (QIV) - Publicly funded for 6 months and older

High Dose QIV (PFS)* - Publicly funded for ages 65 and older

TIV adjuvent (TFS)* - Publicly funded for ages 65 and older

Actual order will depend upon availability of each product.

Delivery by:

Dynacare (Registered participants only)

Bio-Test

Self pick up

On-Demand Courier (delivery within 3 hours)

Please upload your fridge temperature recordings in order to process this order.

Browse…

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

Receive Email Updates...