Out of Province COVID Immunization Form

Waterloo Residents who need to have the COVID-19 immunizations they received outside of Ontario documented in COVaxON should complete this form. COVaxON is the provincial system used to record COVID-19 vaccinations.

There are two instances in which doses must be recorded in the patient’s record:

1. Individuals less than 5 years who have received one or more doses of a non-Health Canada approved COVID-19 vaccine must have their doses recorded to ensure they have completed the appropriate number of doses to ensure optimal protection.

2. Individuals 5 years of age and older who have received one or more doses of a non-Health Canada approved COVID-19 vaccine within the last 6 months must have their doses recorded to ensure subsequent doses (if needed) can be given at the appropriate interval.

Please note: we will be prioritizing requests that meet the criteria outlined above. If you require your doses recorded in COVaxON for another reason (e.g. professional, educational or medical purposes) you can complete this form and we will action your request based on capacity.

If you are not a Waterloo Resident, please contact your local Public Health Unit: Public Health Unit Locator

Public Health uses the information provided in this form to upload information about the doses you received outside of Ontario into COVaxON. Proof of immunization (e.g., an immunization record, proof of vaccination certificate) is required to verify the COVID-19 vaccine product you received out of province, please upload a copy of your receipt and any other supporting documentation (e.g. QR code).

COVID-19 immunizations you receive in Ontario do not need to be reported. When you receive a COVID-19 immunization in Ontario it is documented in COVaxON.

Please do not re-submit this form; this will not speed up the process. Due to the high volume of submissions it may take some time to complete your request. When the immunization(s) you received have been documented in the Ontario health record, we will notify you using the email provided in the form.

If you need help completing this form, contact our Service First Call Centre at 519-575-4608 (TTY: 519-575-4608)