Immunization Clinics (For All Ages) - Haldimand Norfolk

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Client Details

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I'm booking this appointment for my child

Child's First and Last Names

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e.g. M1M 1M1

Ontario Health Card Number

e.g..0000000000

Would you like to receive confirmation and reminder about your vaccine appointment?

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By selecting YES you are agreeing to GEPH to use your email and/or phone number to send you confirmation and reminders about your vaccination appointment as well as confirmation of appointment cancellation or rescheduling. The contact information provided will not be used for any other purpose.

e.g. abc@xyz.com

Cell Phone

e.g. 000-000-0000

If the child attends school, which school? (optional)

Vaccines Required

Vaccine

Client to Pay?

Yes

Notes

I understand that the Grand Erie Public Health - Haldimand Norfolk is only offering Covid-19 and Influenza vaccinations for children aged 5 years and younger.

Personal health information on this web page is collected under the authority of the Health Protection and Promotion Act. It is used to administer the Grand Erie Public Health Vaccine Preventable Diseases (VPD) Program.

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