Request for COVID-19 Vaccination

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Personal health information on this form is collected for the purposes of the provision of health care. Your information will be collected, used and disclosed only as permitted by the Health Information Act, RSPEI 1988, c H-1.41, and other applicable legislation. For more information on privacy and your personal health information, visit www.healthpei.ca/yourprivacy or contact 1-888-561-2233.

Vaccinations are currently being given to certain target population groups. Do not complete this form unless you belong to the target group(s) listed below. Your request will not be processed if you are not in the target group(s).

Check to see if you are in the current target group.

You cannot register for vaccination at this time. You must register at a later date.

The vaccine will be rolled out to target population groups. The vaccine will eventually be available to all PEI residents 18 and older who wish to be immunized against COVID-19. 

Read more about vaccination target groups.