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Date of birth can be typed in MM/DD/YYYY format.
Example: 10/25/1990
10 is for October.
 
Gender
Please enter numbers only without '-', letters or spaces.

 
Personal information is collected under the authority of s. 5(2) of the Health Protection and Promotion Act. This information will be used for the control of disease and the provision of immunization services, in compliance with legal and regulatory requirements. Any questions about the collection of personal information should be addressed to the Chief Privacy Officer, 160 Chancellor’s Way, Guelph ON, N1G 0E1, 1-800-265-7293 ex. 2975, privacy@wdgpublichealth.ca