Vaccine Order Forms and Information

Routine Vaccines and STI Medication

Vaccine pickup times:
Trenton	Monday to Wednesday 8:30 a.m. to 4 p.m.*
Belleville	Monday to Friday – 8:30 a.m. to 4 p.m.
Bancroft	Tuesday and Thursday – 8:30 a.m. to 4 p.m.*
Picton	Monday to Friday – 8:30 a.m. to 4 p.m.*
*No pick ups between noon and 1 p.m. at these offices.

Order Forms

Select the appropriate pdf order form from the list below, and return by fax to 613–966–8145.

1. Vaccine/STI Medication Order Form
2. School Based Vaccine Order Form
3. High Risk Vaccine Order Form
4. Respiratory Syncytial Virus (RSV) Vaccine Order Form

Influenza Vaccine

• Influenza Vaccine Order Form
• Universal Influenza Immunization Program Pharmacy Form

Publicly Funded Immunization Schedules

• Publicly Funded Immunization Schedules for Ontario
• Publicly Funded Immunization Schedule for Ontario – Quick Reference Guide from HPEPH

Returning Vaccines

To return non-reusable vaccines, please complete our Non-Reusable Vaccine Return Record

COVID-19 Vaccinations

• Primary Care Provider Vaccine Readiness Checklist – HPEPH
• COVID-19 Vaccine Order Form – HPEPH
• Storage and handling guidelines for COVID-19 vaccine – Ministry of Health

Learn about Ontario’s vaccination eligibility and recommendations to help protect us against COVID‑19.

For additional information and resources, please visit our COVID-19 Resources for Health Care Providers page.

Immunization Fact Sheets/FAQs

• Ministry of Health Immunization Fact Sheets and Patient Tools
• Shingles vaccine (Zostavax®II) information for Patients
• Publicly Funded Human Papillomavirus Vaccine
• Influenza Vaccine Fact Sheet and Fluzone® Product Monograph
• **Aug 2021 – Important Update About Rotarix**

Exemptions and Vaccine Hesitancy

• Cover letter for exemption affidavits – day care
• Statement of Conscience or Religious Belief Affidavit for Child Care Centres
• Statement of Conscience or Religious Belief Affidavit for JK-grade 12
• Medical Exemption Form
• Working with Vaccine-hesitant Parents
• Your Child’s Best Shot : A Parent’s Guide to Vaccination

Reporting Cold Chain Failures

Vaccines are to be kept between +2 °C and +8 °C at all times. All Health Care Providers should be familiar with the Ministry of Health’s Vaccine Storage and Handling Guidelines. Administering improperly stored vaccines can result in a poor immune response and a lack of protection for clients. If your vaccine has been exposed to temperatures below +2 °C and/or above +8 °C you should:

1. Call Hastings Prince Edward Public Health immediately at 613-966-5500 or 1-800-267-2803, ext. 222 to report the exposure. Public Health staff will conduct an assessment of the exposed vaccine.
2. Segregate the exposed vaccines in the refrigerator by placing these vaccines in a labelled container (or bag), marked with the date, time, and “DO NOT USE”.
3. Check to ensure your temperature monitoring device is working correctly. If in doubt, replace the battery.
4. After checking the temperature monitoring device and the refrigerator, record the date, time and temperature in your temperature log book. Always remember to reset your maximum-minimum thermometer (if applicable) after each recorded temperature.
5. If the current temperature is too low or too high, move these vaccines to a properly functioning, monitored refrigerator, or place the vaccines in an insulated container with ice packs and a temperature monitoring device inside the vaccine package. Insulated containers will only keep vaccines at the appropriate temperatures for a short period of time (approximately two hours).

For more information about Cold Chain, call Hastings Prince Edward Public Health at 613-966-5500 or 1-800-267-2803, ext. 222.

HPEPH’s Role in Providing Immunization Information and Services

In addition to providing immunizations to local health care providers and pharmacies, we offer recurring immunization clinics and appointments at all of our offices, and hold seasonal flu clinics throughout the community.