First Name*

Last Name*

Date of Birth (YYYY-MM-DD)*

Gender*

Saskatchewan Health Services Number

I do not have a Saskatchewan Healthcare Number

Address*

City*

Postal Code*

Phone*

Email Address*

Immunization events that need to be corrected

*At least one Immunization Event and relative info: Brand, Vaccine Date, Clinic/Pharmacy, Clinic Type, City, and Country are required.
*You must wait 2 calendar days before submitting a request regarding any missing or incorrect information for any of your COVID 19 doses

1. Immunization Event*

Vaccine Brand*

Vaccine Date (YYYY-MM-DD)*

Clinic/Pharmacy*

Clinic Type*

City*

Country*

Comment

2. Immunization Event

Vaccine Brand

Vaccine Date (YYYY-MM-DD)

Clinic/Pharmacy

Clinic Type

City

Country

Comment

3. Immunization Event

Vaccine Brand

Vaccine Date (YYYY-MM-DD)

Clinic/Pharmacy

Clinic Type

City

Country

Comment

If 13 years of age or younger is applicable, make my immunization visible in MySaskHealthRecord.

Immunization Records Upload (DO NOT submit a QR code)

Document type: .pdf, .jpg, .jpeg, .png, .gif || Maximum 5 files || Maximum upload size in total: 10MB