Load unfinished survey Resume later 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. Flu Vaccine Order Form The Universal Influenza Immunization Program (UIIP) provides free influenza vaccines to individuals ages 6 months or older who live, work or attend school in Ontario. All influenza vaccines are trivalent this season. As directed by the Ministry of Health, initial influenza vaccine doses will be prioritized for high-risk individuals. For high risk criteria see NACI Statement on seasonal influenza vaccines for 2025–2026 . Providers wishing to conduct influenza community vaccination clinics for the general population must wait until November to ensure that an adequate supply of vaccine can be provided. Available Influenza Vaccine Products: Vaccine Product Dosage Format Age Indication Fluviral 15 mcg/0.5mL Multi-dose vial, 10 doses per vial 6 months of age and older Fluzone 15 mcg/0.5mL Multi-dose vial, 10 doses per vial 6 months of age and older 15 mcg/0.5mL Single dose, pre-filled syringe 6 months of age and older Flucelvax (egg free) 15 mcg/0.5mL Single dose, pre-filled syringe 6 months of age and older Fluzone High-Dose 60 mcg /0.5mL Single dose, pre-filled syringe 65 years of age and older Fluad (adjuvanted vaccine) 15 mcg/0.5mL Single dose, pre-filled syringe 65 years of age and older Additional Resources: Universal Influenza Immunization Program | ontario.ca Influenza Program Resources | The Windsor-Essex County Health Unit Ordering Instructions: Please place your FIRST order by Sept 26th for high-risk patients. Additional orders for vaccine may be placed beginning October 20th. Please be reminded that the number of doses that you receive in your order may be adjusted at the discretion of the public health unit in accordance with vaccine supply. As a result, it is recommended that providers do not book appointments prior to receiving influenza vaccine. To support timely distribution to the community, only one influenza vaccine order per provider per week will be filled. You will be notified by the Windsor-Essex County Health Unit (WECHU) when your order is ready. For vaccine pick up, coolers must be pre-chilled to temperatures between 2-8°C and all transport equipment must be present. If you plan to have your order delivered by Medex; please contact Medex at 519-735-7273 to arrange your delivery. If you have questions, contact the WECHU at vaccine@wechu.org or call 519-258-2146 ext.1121 (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. Choose one of the following answers Delivery (by Medex) Pick-Up at WECHU Windsor office (1005 Ouellette Ave.) Pick-Up at WECHU Leamington office (33 Princess St.) Delivery to Erie Shores HealthCare Hospital (This question is mandatory) Please select the vaccine(s) you would like to order. Select all that apply FLUZONE/FLULAVAL Multi-dose Vial - Trivalent - for individuals 6 months and older FLUZONE HIGH-DOSE Prefilled Syringe - Trivalent - for individuals 65 years and older FLUAD (adjuvanted vaccine) - Prefilled Syringe -Trivalent- for 65 years of age and older FLUVIRAL/FLUZONE - Multi-dose vial (10 doses/vial)-Trivalent- for 6 months of age and older FLUZONE Prefilled Syringe - Trivalent - for individuals 6 months and older FLUCELVAX (egg free) Prefilled Syringe -Trivalent- for individuals 6 months and older (This question is mandatory) Please input the number of doses on hand and the number doses for the vaccine(s) you are requesting. Only numbers may be entered in these fields. Your answer must be between 0 and 500 # Doses on hand # Doses required FLUZONE/FLULAVAL Multi-dose Vial - Trivalent - for individuals 6 months and older # Doses on hand # Doses required FLUZONE HIGH-DOSE Prefilled Syringe - Trivalent - for individuals 65 years and older # Doses on hand # Doses required FLUAD (adjuvanted vaccine) - pre-filled syringe - Trivalent - for 65 years of age and older # Doses on hand # Doses required FLUVIRAL/FLUZONE - Multi-dose vial (10 doses/vial)-Trivalent- for 6 months of age and older # Doses on hand # Doses required FLUZONE Prefilled Syringe - Trivalent - for individuals 6 months and older # Doses on hand # Doses required FLUCELVAX (egg free) Prefilled Syringe -Trivalent- for individuals 6 months and older # Doses on hand # Doses required Please upload fridge logs from the past 4 weeks. Please upload between 1 and 2 files Upload files File name Upload files Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey