COVID-19 Vaccine Order Form for Vaccine Providers

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The information collected on this form will be used to allow the creation of materials for the Immunization Program. The information is collected under the authority of and managed in accordance with the Freedom of Information and Protection of Privacy Act, R.S.P.E.I. 1988, Cap. F-15.01. If you have any questions about the collection, use or disclosure of your personal information, please contact the Immunization Coordinator at the Chief Public Health Office at 902-368-4996.

Enter the security code provided to you by the Chief Public Health Office. Only health care providers with a code may apply.

Contact the Chief Public Health Office at 902-368-4996 for more information.