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Student Health Services

Third party Immunization Policy


Student Health Services 

Third Party Immunization Forms Policy

Third Party Immunization Form

The cost of completion of third party immunization forms is a service that is not covered by provincial or private health insurance plans. Student Health Services (SHS) processes multiple forms each day.  In order to complete these requests effectively we must adhere to the following policy.

  1. SHS has developed a generic, comprehensive Third Party Immunization Form that addresses all possible immunization requirements. Please visit our website: /health to view the Student Health Services Third Party Immunization Form.       

  2. Student Health Services will provide documentation for immunity status, vaccination history and TB screening using only this Third Party Immunization Form.   The cost of completing this form is $40.
  3. To proceed with having a SHS Third Party Immunization Form and all accompanying tests and immunizations, contact the Student Health Services receptionist at 519-973-7002 to book this appointment with the Nurse.   All immunization records and related third party requests must be brought to the appointment.
  4. The Nurse will review the third party requests with the patient and order the necessary laboratory tests and required immunizations.   TB skin tests will be completed and/or chest x-ray requisition will be given.  

    OHIP covers the cost of TB tests for clinical placement.  
    A fee is charged for TB testing needed for paid employment purposes.  
    Cost:   one-step $20;  two-step $25 (if a patient has never had a tb test)

  5. The patient must schedule an appointment with a physician for two weeks after they have their blood work done.  The Student Health Services' Physician will review and sign the SHS Third Party Immunization Form at this appointment.
  6. The cost of the Third Party Immunization Form is $40.00.  Fees are payable at the first appointment.   Cash only.

SHS suggests that this process be started well in advance of form submission deadlines.

 Your patience is appreciated while we try to accommodate you in the timeliest manner possible.

                                    January 2015