Healing Source Pharmacy Flu Shot Request Form
Please fill in the information in this form. We will contact you within 3 business days to book your flu shot appointment at our pharmacy.
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Name (First and Last) *
Date of Birth *
Home Postal Code (e.g. M1P M8M) *
Email (e.g. johndoe@gmail.com) *
Please ensure your email is written correctly.
Telephone (where we can reach you ) *
Please ensure your telephone number is written correctly.
Please download and print the flu shot vaccination consent form. Please complete the form before your appointment. Download Form.
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