2024 / 2025 Flu Shot and COVID book Name * Name First First Last Last Date of Birth * Age * Health Card Number * *if you do not have an Ontario Health Card, simply write "no health card". You can still get a flu or COVID shot without an Ontario Health Card. Address * City * Province * OntarioAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland / LabradorNorthwest TerritoriesNova ScotiaNunavutPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Phone * Email * This patient is younger than 2 years of age. We are only able to administer vaccinations at the pharmacy for patients aged 2 years or older. If you are human, leave this field blank. Next
