Get Vaccine Order Request - Region Of Peel - Peelregion

Filling out the Vaccine Order Request form for the Region Of Peel can be a straightforward process when guided correctly. This step-by-step guide will help users navigate through each section of the form with ease, ensuring that all necessary information is provided.

Follow the steps to successfully complete your Vaccine Order Request

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Enter the order information starting with the 'Order Date' field, where you will select or input the current date.
3. Specify the 'Date of Pick-up,' noting that it will typically be two business days after the order is received, unless otherwise stated in the Delivery or Pick-up Preference section.
4. Fill in the 'Physician/Practice Name,' along with the 'Address,' 'City,' and 'Postal Code' of the practice.
5. Provide the 'Telephone Number' for the practice, followed by the 'Contact Person' who will handle the order.
6. Indicate the 'Type of Practice' that best describes your facility and include the 'Number of Physician(s) and/or NP(s) in facility.'
7. For the 'Delivery or Pick-up Preference,' select one option: either 'Vaccine Delivery' (available to registered participants only) or one of the listed pick-up locations.
8. Complete the section indicating your order quantities for each vaccine listed, ensuring not to exceed the one-month supply limit. Specify the number of doses required.
9. Review the 'Vaccine Storage and Handling Guidelines' statement and confirm compliance by providing the required verification signature and date.
10. Finally, save your changes, download the completed document, print it for your records, or share it as required.

Complete your Vaccine Order Request online today for a seamless submission.