Forms for Health Care Professionals
Forms/Referrals/Ordering
Quick access to the public health forms needed by Health Care Professionals
Order Forms
• Resource Order Form
• Vaccine Order Form
• Vaccine Return Form
• Vaccine Temperature Logs
To order vaccines through fax or email, please email us at vaccineorders@county-lambton.on.ca to receive a fillable form.
Reporting Forms
• Animal Exposure Reporting Form
• AEFI Reporting Form
• Cold Chain Incident Form – Report by phone 519-383-8331
• Facility Outbreak Line List (pdf)
• Report Measles (pdf)
• Reportable Diseases
• Tick Identification Form
• Tuberculosis Reporting Form (pdf)
• Sexual Health Reporting
• Chlamydia and/or Gonorrhea Reporting Form (pdf)
• Syphilis Reporting Form (pdf)
• Vaccine Temperature Logs
Hepatitis B, Hepatitis C and HIV
Report by phone 519-383-8331 extension 3547 or fax 519-383-6310 (during business hours only).
Reporting outbreaks
To report a suspect or confirmed outbreak to LPH, please call 519-383-8331 ext. 3537 from 8:30 am to 4:30 pm Monday to Friday and 519-383-8331 after hours and on weekends and holidays.
Referral Forms
• Community Paramedic Referral Form
• Family Health Referral Form
The Family Health Referral form is for Prenatal Health, Prenatal Classes, Healthy Babies Healthy Children (HBHC) Program, Growth and Development, Infant Feeding and Nutrition, Maternal Mental Health, Food Security, Speech and Language, Social Supports, Oral Health (for children ages 17 and under), Parenting, Other.