Covid-19 Vaccine

ATTN PATIENTS: We are not currently administering COVID-19 vaccinations and do not have information on when we will receive them. Please check back for updates.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Birth Year *

Postal Code *

Health Card Number *

Have you ever received a dose of COVID-19 vaccine? *

Yes No

If yes, which vaccine did you receive? *

Astrazeneca Pfizer Moderna N/A

If yes, please indicate the date of your first vaccination: *

If contacted for a same day appointment, would you be able to get to our location within an hour? (This does not affect eligibility) *

Yes No

Anything else you'd like us to know? *

Submit