If you are interested in receiving either a Pneumovax or RSV Vaccine (or both) at the Sharbot Lake Family Health Team on Tuesday, February 3rd, from 8:30 am to 11:30 am, please complete the following form.

Eligibility:

Pneumonia (Pneumococcal) vaccine: Adults 65 years of age and older
RSV vaccine: Adults 75 years of age and older

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* Patient Information :

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* Which vaccine(s) would you like to receive?

To register additional people, please click on the 'DONE' button at the bottom of this form and then complete the same form again, using the link in the email.
We will be in touch to confirm an appointment time for you.
Personal information on this form is collected under the authority of the Personal Health Information Act 2004, 39. (1) (a)
and will be used by the Sharbot Lake Family Health Team for the purposes of program planning.

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