Report Changes to your Ontario Health Card Information

All individuals are responsible for providing accurate, up-to-date vaccination information.

Residents of Niagara region who have not updated their health card with their chosen name but would like to have their Ontario vaccine certificate reflect their chosen name.

Before completing this form, please carefully review the following:

You will need to upload at least two valid pieces of documentation to process the name change on your vaccine certificate (one with your chosen name and one with your name)
The combination of documents submitted must include name, birth date and photo ID (for those 18 years and older)
The following forms of documentation will be accepted:

Driver's licence
Birth certificate
Ontario photo card
Passport
Piece of registered mail
Pay stub
Student card
Library card
Club or organization ID cards
Government issued identification from other jurisdictions including foreign passports, other provincial or territorial health cards, or driverâ€™s licence

If you have any question or concerns and would like to talk to a public health professional, call 905-688-8248 ext. 7425.

Thank you for submitting your out of province vaccination record. It is very important that you keep your original COVID-19 immunization record stored in a safe location with other valuable documents such as birth certificates, health cards and passports.
 If you have submitted your COVID-19 vaccination record in anticipation of travel, travellers must use ArriveCAN to enter their proof of vaccination. Visit the <A HREF="https://travel.gc.ca/travel-covid/travel-restrictions/covid-vaccinated-travellers-entering-canada#vaccinated?utm_source=eo-email&utm_medium=email-response&utm_content=nov-2020&utm_campaign=hc-sc-covid-20-21">COVID-19 vaccinated traveller entering Canada website</A> for more detailed information regarding providing proof of vaccination.
 If you have any question or concerns, and would like to talk to a public health professional, contact the Novel Coronavirus (COVID-19) Info-Line: 905-688-8248 or 1-888-505-6074, press 7, Monday to Friday, 8:30 a.m. to 4:15 p.m.

* = Required

Contact Information

* First name

* Last name

* Reason for submission

* Phone number
xxx-xxx-xxxx

* Email

* Gender

* Date of birth

Niagara address
If you don't have an Niagara address, wait until you have one to submit your record

* Street number

* Street name

* City

* Postal code

Identification Information

Current legal name identification

Type of identification

* Legal name identification image

Chosen name identification

* Chosen name updated First name
Middle name
Last name

Type of identification

* Legal name identification image

I would like to have my chosen name updated on my COVID-19 Vaccine Certificate and understand I may be contacted by Niagara Region Public Health to further verify my identity

Contacting

You may be contacted by a hospital, local public health unit or the Ministry of Health for purposes related to the COVID-19 vaccine (for example, to remind you of follow up appointments and to provide you with a record of immunization). You must consent to this to complete this form.

I consent to receiving follow-up communications by email or phone

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.