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Licensed Child Care Entry Immunization Form

Updated: June 2019

Gastrointestinal Outbreak Line Listing Form - Child Care

Reviewed: June 2022

Non-Reusable Vaccine (Spoiled or Expired) Return Form

Updated: 2021

IMT-218 - Publicly Funded Hepatitis A & Hepatitis B Order/Report Form

Updated: March 2019

Hep B Vaccine Order And Referral Form

Statement of Medical Exemption COVID-19 Immunization- Public Use

Flu Vaccine Wastage Form - Pharmacy

Updated September 2023.

Flu Vaccine Wastage Form - Health Care Providers

Updated September 2023.

2023-2024 Seasonal Influenza Consent Form

Updated October 2023.

Vaccine Temperature Log Book

Updated September 2023.

Consentement à l’administration du vaccin Menactra

Take Control: Personal Tobacco-Free Counselling

Referral form for the Take Control clinic at the TBDHU.

Updated: March 2024

Modified COVID-19 Vaccination Clinic Daily Metrics Form

Updated September, 2024

Flu Vaccine Order Form - Thunder Bay orders only

Updated September 2024.

For district orders, see HERE.

District Branch Offices - Vaccine Order Forms - Routine, Grade 7 and High Risk Vaccines

District Providers - Select the order form for the branch office nearest to your practice.

The form can be emailed or faxed using the contact information provided on the form.

Updated: September 2024.