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Better Sleep
Calming Difficult Emotions Group - 7 sessions
Caregiver's Coffee Hour
CBT for Anxiety & Depression - 6 Classes
Feeding Your Baby - Introducing Solid Food
Heart Health
Relaxation & Stress Management Skills - 6 Sessions
The Highs & Lows of Diabetes
The Mediterranean Diet for Good Health
Understanding Pre-Diabetes
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COVID-19 at EWFHT
COVID-19 Information Centre
Clinic Hours
Fees & Services
Health Card FAQs
Online Booking
Prescriptions
Saturday Urgent Care
Waitlist Application
Walk-In Clinics
What's New in Healthcare!
Zero Tolerance Policy

Flu Shot or COVID-19 Vaccination Elsewhere

If you did not receive a flu shot or COVID-19 vaccination at your family doctor's office, please let us know where you received it and the (approximate) date.  (Only complete relevant answers, leave others blank.)

Name:
Date of Birth (DD-MM-YYYY):
I received my flu shot at:
Approximate date of flu shot (DD-MM-YYYY):
I received my COVID vaccination at (location):
Approximate date of COVID vaccine (DD-MM-YYYY):
I received:
Dose 1
Dose 2
The type I received is:
AstraZeneca
Moderna
Pfizer
Other/Unsure
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Unit 1 • 6 Thompson Crescent • Erin ON N0B 1T0 • Phone: (519) 833-9396
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