COVID-19 Immunization Record Update Request Form
First Name
*
required
Only alphabet, hyphen, apostrophe, dot and space are allowed.
Last Name
*
required
Only alphabet, hyphen, apostrophe, dot and space are allowed.
Date of Birth (YYYY-MM-DD)
*
required.
Gender
*
required
Please select...
Female
Male
Other
Saskatchewan Health Services Number
I
do not have
a Saskatchewan Healthcare Number
You must submit an active HSN number or select "I do not have a Saskatchewan Healthcare Number"
Address
*
Address is required
City
*
required
Postal Code
*
invalid code
required
Phone
*
required
Invalid Phone Number.
Email Address
*
required
Please provide a valid 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
*
Please select...
Missing Dose
Missing Lot Number
Incorrect Date of immunization
Duplicate Entry
Out of Province
required
Vaccine Brand
*
Please select...
AstraZeneca
CanSinoBIO Ad5-n CoV
CoronaVac/SinoVac Inact Vero Cell
Covaxin Vero Cell
Covishield
Covovax rS
Janssen
Medicago CoVLP
Moderna
Moderna PEDS 6m-5y
Moderna Spikevax Bivalent
Novavax NVX-CoV2373
Pfizer
Pfizer 6m - 4y
Pfizer Bivalent
Pfizer Pediatric
SinoPharm Vero Cell
Sputnik Light rAD
Sputnik V rAD
Zifivax (ZF2001)
required
Vaccine Date (YYYY-MM-DD)
*
Required. You must wait 2 calendar days before submitting a request regarding any missing or incorrect information for any of your COVID 19 doses.
Clinic/Pharmacy
*
required
Clinic Type
*
Please select...
Walk-in
Drive Thru
Appointment
required
City
*
required
Country
*
required
Comment
limit 300 characters. Only alphabet, hyphen, apostrophe, dot and space are allowed.
2.
Immunization Event
Please select...
Missing Dose
Missing Lot Number
Incorrect Date of immunization
Duplicate Entry
Out of Province
Vaccine Brand
Please select...
AstraZeneca
CanSinoBIO Ad5-n CoV
CoronaVac/SinoVac Inact Vero Cell
Covaxin Vero Cell
Covishield
Covovax rS
Janssen
Medicago CoVLP
Moderna
Moderna PEDS 6m-5y
Moderna Spikevax Bivalent
Novavax NVX-CoV2373
Pfizer
Pfizer 6m - 4y
Pfizer Bivalent
Pfizer Pediatric
SinoPharm Vero Cell
Sputnik Light rAD
Sputnik V rAD
Zifivax (ZF2001)
Vaccine Date (YYYY-MM-DD)
Clinic/Pharmacy
Clinic Type
Please select...
Walk-in
Drive Thru
Appointment
City
Country
Comment
limit 300 characters. Only alphabet, hyphen, apostrophe, dot and space are allowed.
3.
Immunization Event
Please select...
Missing Dose
Missing Lot Number
Incorrect Date of immunization
Duplicate Entry
Out of Province
Vaccine Brand
Please select...
AstraZeneca
CanSinoBIO Ad5-n CoV
CoronaVac/SinoVac Inact Vero Cell
Covaxin Vero Cell
Covishield
Covovax rS
Janssen
Medicago CoVLP
Moderna
Moderna PEDS 6m-5y
Moderna Spikevax Bivalent
Novavax NVX-CoV2373
Pfizer
Pfizer 6m - 4y
Pfizer Bivalent
Pfizer Pediatric
SinoPharm Vero Cell
Sputnik Light rAD
Sputnik V rAD
Zifivax (ZF2001)
Vaccine Date (YYYY-MM-DD)
Clinic/Pharmacy
Clinic Type
Please select...
Walk-in
Drive Thru
Appointment
City
Country
Comment
limit 300 characters. Only alphabet, hyphen, apostrophe, dot and space are allowed.
Please upload your documents as you select Out of Province Immnunization Event.
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
Captcha Required