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Forms

Update about vaccine and medication orders during COVID-19

Visit affected services and facilities for current information about vaccine and medication orders.

Ordering

Influenza vaccine order form
Bicillin Order Form for Single Orders (Region of Peel) (2019)
Online Vaccine Order Form (Region of Peel) (2019)
STI Treatment Order Form (Peel Public Health) (2019)
High Risk Meningococcal Vaccine Requisition (Region of Peel) (2021)
Hepatitis A Vaccine Requisition (Region of Peel) (2021)
Hepatitis B Vaccine Requisition (Region of Peel) (2016)
High-Risk Hepatitis B Program for Children <7 years (Region of Peel) (2012)
Bicillin Order Form for Bulk Orders (Region of Peel) (2019)
Reporting Positive Skin Test and TB Drug Order (Region of Peel) (2012)
Tubersol Paid Vaccine Delivery Program (Region of Peel) (2011)
Where to Pick Up Your Vaccine Order (Peel Public Health) (2011)
Health Canada's Special Access Programme (SAP) Instructions for Making a Special Access Future Use Request Form B (Health Canada) (2008)
Sign up for the Paid Vaccine and STI Med Delivery Program (Critical Path courier)
- Fax completed CP Account Activation form to Peel Public Health at (905) 565-9874.
- Critical Path will contact you directly to collect billing information requested on the form.
High-Risk HPV vaccine requisition (MSM)

Forms

Reporting

Notification of New Active or Reactivated Tuberculosis Case (Region of Peel) (2011)
Report of Adverse Events Following Immunization (AEFI) (Public Health Ontario)

Fax completed AEFI form to Region of Peel – Public Health at
905-565-0426.

Reporting Positive Skin Test and TB Drug Order (Region of Peel) (2012)
Vaccine Cold Chain Incident and/or Wastage Report (Region of Peel) (2017)
Tuberculosis Assessment Referral Form (Region of Peel) (2010)

Forms

TB Clinic Referral

Tuberculosis Clinic Referral

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Revised: May 04, 2023

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