Halton Region Online Self-Service

The COVID-19 vaccination service for homebound residents is available to Halton residents who are unable to leave their homes. To be eligible for this service, the person must be unable to physically leave their home or leaving home requires a considerable effort. For example, the person normally does not leave their home on their own (with or without support) to access medical, public, or social services.

Please note:

This is not a rapid referral program. Halton Region Public Health will contact applicants within two to four weeks of receiving an application.

Lack of access to transportation does not define an individual as homebound. There are a range of safe and reliable transportation options, including special transit services for older adults and people with disabilities. For more information on transportation options available, please visit Transportation Options for Older Adults

You can only register one person at a time.

Please select the status which best applies to you. (required)

Congregate Living Administrator

Physician or Health Care Provider

Eligible Halton Resident or Substitute Decision Maker

I am registering for:

Myself (Client)

Someone Else

Relationship to Client

Parent/Legal Guardian

Spouse/Partner

Caregiver/Substitute Decision Maker*

*If the client is incapable of consenting to the collection, use and disclosure of their personal health information, you are the individual with legal authority to provide consent for the purpose of this form. If no legal authority has been set-up, or if the client is capable of providing consent to the handling of their personal health information, you are the individual who has received authorization from the client to provide consent on their behalf.

Which community does the client (person receiving vaccine) live in?

Burlington

Halton Hills

Milton

Oakville

I consent that the client (person receiving the vaccine) is unable to leave their home on their own (with or without support) to access medical, public, or social services.

Yes

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