FORMS

Rapid Antigen Testing Now Available!

We now offer rapid antigen testing for asymptomatic individuals who are travelling.

$79 + HST – BOOK YOUR APPOINTMENT BELOW

Influenza Vaccine Screening Form

Please fill out and submit this form before coming for your influenza vaccine appointment. 

The following questions will help us determine if there is any reason you or your child should not get the vaccine today.
If you answer "yes" to any question, it does not necessarily mean the shot cannot be given.
It simply means additional questions must be asked.

If a question is not clear, please ask your pharmacist to explain it.
I, the undersigned client, parent or guardian, have read or had explained to me information about the flu shot as outlined on the Fact Sheet. I have had a chance to ask questions, and answers were given to my satisfaction. I understand the risks and benefits of receiving the flu shot. I agree to wait in the pharmacy for 15 minutes (or time recommended by the pharmacist) after getting the flu shot. I am aware that it is possible (yet rare) to have an extreme allergic reaction to any component of the vaccine. Some serious reactions called "anaphylaxis" can be life-threatening and is a medical emergency. If I experience such a reaction following vaccination, I am aware that it may require the administration of epinephrine, diphenhydramine, beta-agonists, and/or antihistamines to try to treat this reaction and that 9-1-1 will be called to provide additional assistance to the immunizer. The symptoms of an anaphylactic reaction may include hives, difficulty breathing, swelling of the tongue, throat, and/or lips. In the event of anaphylaxis, I will receive a copy of this form containing information on emergency treatments that I had received, or a copy will be provided to my agent or EMS paramedics.
If your child is less than 9 years of age, and getting the influenza vaccine for the first time, your child will need 2 doses of vaccine this season. They are given at least 4 weeks apart.
Thank you for submitting your form. We will contact you to book an appointment once the vaccine becomes available

Influenza & COVID Vaccine Screening Forms

Please fill out and submit this form before coming for your vaccine appointment. 

I, the undersigned client, parent or guardian, have read or had explained to me information about the flu shot as outlined on the Fact Sheet. I have had a chance to ask questions, and answers were given to my satisfaction. I understand the risks and benefits of receiving the flu shot. I agree to wait in the pharmacy for 15 minutes (or time recommended by the pharmacist) after getting the flu shot. I am aware that it is possible (yet rare) to have an extreme allergic reaction to any component of the vaccine. Some serious reactions called "anaphylaxis" can be life-threatening and is a medical emergency. If I experience such a reaction following vaccination, I am aware that it may require the administration of epinephrine, diphenhydramine, beta-agonists, and/or antihistamines to try to treat this reaction and that 9-1-1 will be called to provide additional assistance to the immunizer. The symptoms of an anaphylactic reaction may include hives, difficulty breathing, swelling of the tongue, throat, and/or lips. In the event of anaphylaxis, I will receive a copy of this form containing information on emergency treatments that I had received, or a copy will be provided to my agent or EMS paramedics.
If your child is less than 9 years of age, and getting the influenza vaccine for the first time, your child will need 2 doses of vaccine this season. They are given at least 4 weeks apart.
Thank you for submitting your form. We will contact you to book an appointment once the vaccine becomes available

Rapid Antigen Testing Agreement

Patient shall indemnify to the fullest extent of the law, defend and hold Total Health Pharmacy, its affiliates and their respective directors, officers, employees, agents, successors and assigns (collectively, “Total Health Pharmacy Indemnitees”) harmless from and against any and all damages, including but not limited to on account of injury to persons including death or damage in any way caused by negligence of Total Health Pharmacy Indemnitees, any losses judgments, arbitration awards, settlements, claims, suits, penalties, fines, actions, liabilities, costs and expenses (including, but not limited to, reasonable attorneys’ fees) resulting from any Third Party claims or suits arising out of (a) the use, handling, shipping, importation, exportation, storage, transportation, distribution and disposition processes (including but not limited to specimen collection, transcription, data entry, and delivery) of Private COVID-19 tests (b) Total Health Pharmacy Indemnitees will not be responsible for any delays including but not limited to: inconclusive/indeterminate/false positive and false negative results, missing information/ misinformation, results being displayed/interpreted incorrectly by airlines, delays in receiving results, and any and all incorrect information entered by Total Health Pharmacy Indemnitees or the laboratories. A negative result does NOT preclude SARS-CoV-2 infection and should not be used as the sole basis for patient management decisions. In case of unexpected results, a negative result must be combined with clinical observations, patient history and epidemiological information.

Patient understands and agrees that by paying for this test and/or signing this agreement the Patient agrees not to disparage or encourage others to disparage Total Health Pharmacy Indemnitees. For the purposes of this agreement, the term disparage includes without limitation comments or statements made in any matter or medium in the press and/or the media about Total Health Pharmacy Indemnitees which in any manner likely be harmful to Total Health Pharmacy Indemnitees or their business, business reputation or personal reputation, which would adversely affect any manner of the conduct of the business of Total Health Pharmacy Indemnitees and understands and agrees that the Patient or anyone acting on behalf of the Patient will not disparage or denigrate Total Health Pharmacy Indemnitees orally or in writing, and that neither the Patient nor anyone acting on Patient’s behalf will publish, post, or otherwise release any material in written or electronic format, make speeches, gain interviews, or make public statements that mentions Total Health Pharmacy Indemnitees, its operations, clients, employees, products, or services.

Eligible patients for private travel for Private COVID-19 testing understand that there are no guarantees on return of test results and it is the Patient’s responsibility to obtain all applicable travel insurances in case of delays, inconclusive or indeterminate results (including false positives).

By agreeing, you hereby consent to receive your results by email. Furthermore, you are agreeing that the integrity and security of this email cannot be guaranteed over the Internet. Therefore, Total Health Pharmacy Indemnitees will not be held liable for any damages or delays caused by the message.