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Mobile COVID-19 Vaccination Community Clinic Requests

We invite organizations serving vulnerable populations, congregate care settings, and organizations willing to support a clinic for residents experiencing barriers to complete this form to request a mobile vaccination clinic. These clinics are organized and staffed by Ottawa Public Health (OPH). An OPH staff member will contact you via phone or email to follow-up on review this request and to discuss any potential next steps. A limited number of mobile clinics are available Tuesdays through Saturdays. We are not able to accommodate all mobile clinic requests.

All information provided in this form is confidential and used by OPH for the purposes of planning mobile COVID-19 community vaccination clinics.

This form is not for requesting a homebound vaccination. To enquire about homebound vaccinations, please follow the instructions listed under the question “Am I eligible for in-home vaccination?”, found here.

Name of workplace/organization/group

Primary contact name (First and Last name)

Primary email address

Primary phone number

Optional - Secondary contact name (First and Last name)

Secondary email address

Secondary phone number

Address

Postal code

Would the vaccination clinic be hosted at this location?

Yes

No - other location(s)

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Mobile COVID-19 Vaccination Community Clinic Requests

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