Screening for COVID-19 Vaccine Eligibility at Osler
Who is vaccinated, when and where is determined by the Ministry of Health and in partnership with individual public health units (e.g. Peel Public Health).
By completing this form, you are ensuring that you are eligible to receive the COVID-19 vaccine based on public health sequencing.
For more information about who is eligible and when you can receive the vaccine, please visit
Peel Public Health.
**Note: Before receiving the vaccine at the clinic, you may be required to provide:
Proof of age (e.g. government issued identification).
Proof of residency (e.g. proof of address)
Eligible health care workers
must bring the following documents to their vaccination clinic appointment:
Government issued photo identification (e.g., driver’s license, health card)
One supporting document that shows they are an active health care worker (e.g., ID badge, business card, letter from supervisor on letterhead, pay slip, proof of active membership in a relevant professional college/licensing association, e.g., CPSO, CDHO)
If you are not eligible, the clinic will not be proceeding with the vaccination
Do you work or live in Osler's catchment area of Peel Region or Etobicoke?
Are you currently:
12+ living, working or attending school in Peel Region, or North Etobicoke?
Has your physician identified you (and 1 essential caregiver) as a patient with a high risk health condition in the list below?
Organ Transplant recipients
Hematopoietic stem cell transplant recipients
Neurological disease in which respiratory function may be compromised (e.g. motor neuron disease, myasthenia grave, multiple sclerosis)
Haematological malignancy diagnosed less than 1 year
Kidney disease eGFR less than 30
Obesity (BMI greater than 40)
Other treatments causing immunosuppression (e.g., chemotherapy, immunity weakening medications)
Intellectual or developmental disabilities (e.g., Down Syndrome)
Are you included in the first or second group of essential workers
listed by the Ministry of Health
who cannot work from home?
I confirm that the information provided is correct and accurate.