Search

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.

Consentement à l’administration du vaccin Menactra

All animal biting incidents, including those involving owners who have been bitten by their own animal, are to be reported to the Medical Officer of Health in accordance with the Health Protection and Promotion Act and the Rabies Prevention and Control Protocol, 2018 (or as current).

Note:…

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.