ISPA Clinic Booking Tool

Prebooking Screening
Client and Vaccine Info
Confirmation

Confirmation Message will pop-up here!

Prebooking Screening:

1) Did you/your child receive a notice about suspension by mail or phone?

Yes

2)Are you/your child born in:

⚠️ You cannot book an appointment at one of our community ISPA vaccine clinics. Please speak with a member of our team for further details at 519 753 4937 ext.451

To assist in determining what vaccines are missing from you/your child’s record, please bring a copy of the historical vaccine record (sometimes referred to as the "Yellow Card") to the appointment. This includes a record of all vaccines previously received in Ontario, other provinces or in other countries. Your family doctor or health care provider is not required to share this information with Public Health. It is the responsibility of the parent/legal guardian

I have read and understood

Appointment

Date

No dates are available

Time

No time slots are available

Client Details

First name

Last name

Date Of Birth (yyyy/mm/dd)

Gender

Ontario Health Card #

e.g..0000000000

Postal Code

e.g. M1M 1M1

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

Yes

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

I have read, understand and agree to the Grand Erie Public Health – Brantford Brant's Privacy Statement regarding the collection of information.

Confirmation message

Confirmation Message will pop-up here!