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Clients with no Healthcard

Please note required fields are marked with an * Asterisk.

YYYY-MM-DD , i.e. 2009-05-26 (12 and older)
* Please Acknowledge
  • I confirm that I have not received my first dose of COVID-19 vaccine
  • I do not have an Ontario Health Card
  • I meet the current provincial eligibility criteria for a COVID-19 vaccine

“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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