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Clinic Information Form

If you would like to add, remove or edit your clinic information to the list of locations where vaccines are administered, please fill out the form below. A representative will contact you in 5 to 7 business days to confirm your listing on Vaccines411.

All fields marked with a * are required

*

Add Clinic Remove Clinic Edit My Information

* Clinic Name:

* Address:

* City:

* Province:

* Postal Code:

* Contact Person:

Secondary Contact:

* Phone Number:

Extension:

Fax Number:

Website:

* Email Address:

* Please choose a reason:

We no longer administer vaccines at our clinic.

Our clinic has closed.

We cannot take on new patients.

Other, please specify:

This field is required.

* Communication Preference:

Email Fax

* Language Preference:

English French

Where did you hear about Vaccines411?

Web Search Colleague Social Media Vaccines411^® Communication Pharma Representative

Other, please specify:

This field is required.

* Please select all vaccines that you administer at your clinic/office.

Chikungunya

Cholera

Diphtheria, Tetanus and Pertussis (DTaP) (Children)

Enhanced Influenza (65+)

Haemophilus Influenzae Type B (Hib)

Hepatitis A

Hepatitis A + B

Hepatitis B

Human papillomavirus (HPV)

Influenza

Japanese Encephalitis

Meningococcal A, C, Y, W135 Conjugate (Quadrivalent)

Meningococcal Group C Conjugate

Meningococcal Serogroup B

Measles, Mumps and Rubella (MMR)

Measles Mumps Rubella and Varicella Vaccine (MMRV)

Pneumococcal

Pneumococcal Conjugate Adult

Pneumococcal Conjugate Infant

Pneumococcal Polysaccharide

Polio

Purified Protein Derivative (PPD – Mantoux Test)

Rabies

Rotavirus

RSV (Respiratory Syncytial Virus)

SARS-COV-2 (COVID-19)

SARS-COV-2 (COVID-19) (Children)

Shingles

Tetanus

Tetanus, Diphtheria and Pertussis (Td & Tdap) (Adults)

Travellers' Diarrhea

Tuberculosis (BCG)

Typhoid Fever

Varicella

Yellow Fever

Other , please specify:

This field is required.

* Do you have a minimum age requirement?

No Yes

Specify:

This field is required.

* Do you offer online appointment bookings?

No Yes

URL:

* Do you offer COVID-19 testing?

No Yes

* Do you offer on-site vaccination services to businesses, schools, homes or other locations?
*Please note that if you click yes to on-site vaccination, we will follow-up shortly by phone for more information.

No Yes

Special Instructions or Notes

October 2024

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Last Updated: November 18, 2024