Under-vaccinated Patients

Purpose

This appointment request form is for Magenta Health patients who are intentionally under-vaccinated.

Please fill out the form below in order to request an in-person appointment with your physician.

A member of our admin team will contact you directly via phone to book an appointment during the least busy times in clinic.

Patient Name

(child's name)

First Name

Last Name

Patient's OHIP Number

(child's 10-digit healthcard number)

Phone

(###)

###

####

Reason for Requested Appointment

I understand that clinic staff will offer me a specific set of times, and if none are suitable it will be recommended that we visit a walk-in clinic or ER, as suitable to our needs.

Yes

Background

Magenta Health recognizes its responsibility to protect immuno-compromised individuals who visit our clinic. This includes patients medically unable to be immunized, children too young to yet receive their vaccinations, the elderly, patients with cancer, pregnant women, and patients with diabetes.

This approach is taken to mitigate the risks associated with the co-mingling of under-vaccinated and immuno-compromised individuals within our waiting room and clinic generally. Our full Clinic Vaccination Policy is available here.