Toggle navigation Load unfinished survey Resume later Exit and clear survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. COVID-19 Vaccine Online Order Form Who is Eligible and When COVID-19 vaccine is currently available for high-risk and priority populations. High-risk include adults 65 years of age or older; and individuals 6 months of age and older who are/have: residents of long-term care homes and other congregate living settings pregnant in or from First Nations, Métis or Inuit communities members of racialized and other equity-deserving communities those who have underlying medical conditions that places them at higher risk of severe COVID-19, including children with complex health needs Priority populations: children 6 months to 4 years of age staff and care providers of long-term care homes and other congregate living settings health care workers first responders individuals with significant exposure to birds and mammals (such as poultry, livestock, slaughterhouse and processing plant workers, wildlife officers/researchers, and veterinarians) COVID-19 vaccine will be available to the general public beginning October 28th, 2024. Vaccine Order Instructions Please only order an amount of vaccine that you can administer in a 30 day period. Order fulfillment is subject to vaccine availability. Our team will follow up if there are delays in fulfilling your order. If the population you are planning to immunize is 12 years of age and older, please order Pfizer vaccine. Vaccine product may be substituted based on availability. Wednesday is the designated delivery and pick-up day. You must submit your order by Monday at 4:30p.m. for same week delivery or pick up. Before receiving and administering any COVID-19 vaccines, review the Ministry of Health and Long Term Care COVID-19 Vaccine Program website for COVID-19 vaccine administration, storage, and handling guidelines to ensure you have the most up to date information. COVID-19 vaccine inventory and administration are documented in COVaxON. To be able to order and administer COVID-19 vaccine you must have an active COVaxON account. To maintain an active COVaxON account, users must log in at least once every 3 weeks. Contact the WECHU at vaccine@wechu.org or call 519-258-2146 ext. 1121 for new COVaxON account registration, account re-activation requests, and permission changes, or if you have questions about COVaxON documentation. To learn more about COVaxON please visit the WECHU COVID-19 Vaccine Program for Health Care Providers webpage. (This question is mandatory) Does your organization have at least one staff with an active COVaxOn account? Choose one of the following answers Yes No An active COVaxON account is required to order and administer COVID-19 vaccines. Please do not submit an order and contact the WECHU at vaccine@wechu.org or call 519-258-2146 ext. 1121 for new COVaxON account registration, account re-activation requests, and permission changes, or if you have questions about COVaxON documentation. WECHU COVaxON Immunizer Training Video Ontario Ministry of Health COVaxON Resources for Vaccinators consolidated reference guide. (This question is mandatory) Please enter your office information: Organization/Provider Name Address Phone Number Fax Number Contact Name (First and Last) Email Add line (This question is mandatory) Select delivery or pick-up. Providers ordering COVID-19 vaccine may use Medex to have vaccine orders delivered. For more information on fees and/or to set up an account, contact Medex at 519-735-7273. Choose one of the following answers Pick-Up - Windsor Location - 1005 Ouellette Ave, Windsor - Pick up beginning at 9:30 a.m. or later. Pick-Up - Leamington Location - 33 Princess St, Leamington - Pick up beginning at 11:00 a.m. or later. Delivery (Medex) - For more information on fees and/or to set up an account, contact Medex at 519-735-7273. Delivery to Erie Shores HealthCare Hospital Please select a delivery date. Answer must be greater or equal to 09.02.2025 Date format: dd.mm.yyyy Open date/time selector Format: dd.mm.yyyy 2025-02-09 2037-12-31 DD.MM.YYYY Deadline to submit vaccine orders is Monday by 4:30 p.m. for same week delivery and pick up. (This question is mandatory) Please select the vaccine(s) you would like to order. If the population you are planning to immunize is 12 years of age and older, please order Pfizer vaccine. Vaccine product may be substituted based on availability. Check all that apply Moderna KP.2 for those ≥6 months of age (5 adult doses per vial) Pfizer KP.2 for those ≥12 years of age (6 doses per vial) (This question is mandatory) Please input the number of vial(s) you have on hand and the number of vial(s) you are requesting. Only numbers may be entered in these fields. Each answer must be between 0 and 500 # of vials on hand # of vials required Moderna KP.2 for those ≥6 months of age (5 adult doses per vial) # of vials on hand # of vials required Pfizer KP.2 for those ≥12 years of age (6 doses per vial) # of vials on hand # of vials required # of vials on hand # of vials required # of vials on hand # of vials required # of vials on hand # of vials required Please upload fridge logs from the past 4 weeks. Please upload between 1 and 2 files Upload files × Upload files Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×