Main Drug Mart
2560 Gerrard St E, Toronto · 416-693-7747
Flu and/or COVID shot
Start
No open times right now. Call
416-693-7747
.
✕ Remove this person
Book
Which vaccine? Tick one or both
Last name
(as on the health card)
First name
Date of birth
Month
Sex (as on the health card)
F
M
X
I have an Ontario health card
I don't have an Ontario health card
Health card number
Already a patient here
Please show our team this ID when you arrive.
ID
Choose…
ID number
I live, work, or go to school in
Ontario
.
Street address
City
Postal code
Cell phone
Email
Back
Next
✕ Remove this person
Health questions
Back
Next
✕ Remove this person
Record and contact
Cell number for texts
Email address
Back
Next
✕ Remove this person
Consent
Who is signing?
I am this person
I am signing for this person
Your full name
Relationship
Choose…
Parent
Legal guardian
Spouse / partner
Substitute decision-maker
Sign with your finger
Sign here
Clear signature
Back
Sign
Ready to send
Day
Time
Phone number
Send
+ Add another person
✅
Done. Thank you!