Influenza Vaccine Order Form

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Flu Vaccine Order Form

The Universal Influenza Immunization Program (UIPI) provides free influenza vaccines to Ontarians. People ages 6 months or older who live, work or attend school in Ontario can get the influenza vaccine.

Available Influenza Vaccine Products for the 2024-2025 Season

High Dose Quadrivalent Inactivated Vaccine (QIV-HD)

Brand Name: Fluzone® High Dose

For individuals 65 years of age and older
Supplied in pre-filled syringes
0.7 ml dose

Adjuvanted Trivalent Inactivated Vaccine (TIV-Adj)

Brand Name: Fluad®

For individuals 65 years of age and older
Supplied in pre-filled syringes
0.5 ml dose

Quadrivalent Inactivated Vaccine (QIV)

Brand Names: Fluzone® Quadrivalent, FluLaval Tetra, Flucelvax® Quad

For individuals 6 months of age and older
Supplied in multi-dose vials or pre-filled syringes
0.5 ml dose
Flucelvax is egg free

Initial doses of influenza vaccine are prioritized for high-risk individuals as directed by the Ministry of Health and Long-Term Care. Fluad will be available to order beginning October 21st.

See list in the link: NACI High-Risk Eligibility Criteria for Flu Vaccine

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.

Please place your FIRST order by Sept 23^rd for high- risk patients.

Reorders may be placed beginning October 21^st.

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 1 influenza vaccine order per week will be filled.

You will be notified by the WECHU when your order is ready.

If you have questions, contact the WECHU at vaccine@wechu.org or call 519-258-2146 ext.1121.

Please enter your office information:

Organization/Provider Name
Address
Phone Number
Fax Number
Contact Name (First and Last)
Email

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

Please select the vaccine(s) you would like to order.

Check all that apply

FLUZONE/FLULAVAL Multi-dose Vial - Quadrivalent - for individuals 6 months and older
FLUZONE Prefilled Syringe - Quadrivalent - for individuals 6 months and older
FLUZONE HIGH-DOSE Prefilled Syringe - Quadrivalent - for individuals 65 years and older
FLUAD Prefilled Syringe Adjuvanted Trivalent - for individuals 65 years and older
FLUCELVAX - EGG FREE Quadrivalent Prefilled Syringe or Multi-dose vial - for individuals 6 months and older

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.

Each answer must be between 0 and 500

	# Doses on hand	# Doses required
FLUZONE/FLULAVAL Multi-dose Vial - Quadrivalent - for individuals 6 months and older	# Doses on hand	# Doses required
FLUZONE Prefilled Syringe - Quadrivalent - for individuals 6 months and older	# Doses on hand	# Doses required
FLUZONE HIGH-DOSE Prefilled Syringe - Quadrivalent - for individuals 65 years and older	# Doses on hand	# Doses required
FLUAD Prefilled Syringe Adjuvanted Trivalent - for individuals 65 years and older	# Doses on hand	# Doses required
FLUCELVAX - EGG FREE Quadrivalent Prefilled Syringe or Multi-dose vial - 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

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