Influenza Vaccine Order Forms for Community Vaccine Providers

For use by Community Vaccine Providers only.

For your first order, please request only the vaccine you need to meet your initial requirements. Place subsequent vaccine orders as needed.

Influenza vaccine will be distributed to Community Vaccine Providers based on available supply. If an ordered vaccine is no longer available, another equivalent product will be supplied in lieu.

If no vaccine product is available or a substitution is not acceptable, we will NOT backfill orders. Providers will need to submit another order for additional vaccine or for a different vaccine product when it becomes available.

Agriflu® and Fluviral® will be available; however, Agriflu® single dose vials require nine times the fridge space compared to the equivalent doses of Fluviral®.

Fluzone® Quadrivalent, Flulaval Tetra® and Flumist® Quadrivalent are available for pediatric patients. Please be advised that FluMist© Quadrivalent requires approximately twelve times more storage than an equivalent number of Fluviral© doses.

For more information, visit the Community Vaccine Providers page.

All order forms provided below are provided as PDFs.

South Island

Greater Victoria, Sooke, Saanich, Outer Gulf Islands

Central Island

Duncan, Lake Cowichan, Nanaimo, Parksville, Qualicum Beach, Port Alberni, and Tofino

North Island

Alert Bay, Campbell River, Comox Valley, Gold River, Hornby Island, Port Hardy, Port McNeill, Quadra Island and Woss


Page updated: Sept 13, 2017