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COVID-19 Vaccine Pre-Registration

Contact Details

Please note required fields are marked with an * Asterisk.

Format: A1A 1A1
Format: ###-###-####
YYYY-MM-DD , for example (1980-01-21)
(Enter numeric values only with no dashes or spaces. eg.9999999999)
If you don't have an Ontario Health Card Number please enter all zero's (i.e. 0000000000)

At this time, only the following people are eligible to pre-register for their COVID-19 vaccine. Please choose the group you belong to:

* Please Acknowledge

“The Health Unit collects personal information in the course of doing business. Personal information about you is collected directly from you or from the person acting on your behalf. Personal health information collected may include, for example, your name, date of birth, address, contact information, health card number, health history, and information you provide during visits or calls to the health unit.”
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If you have any questions or concerns that require a response, please contact Health Connection directly.

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