Health Care Professionals Resource Ordering Form Resource Order FormResources to help support your practice & the health of your patients. These resources can only be ordered by health care provider offices (for example, physician / primary care settings), long-term care homes and retirement homes. Many resources are downloadable and print ready for convenience. For hardcopy resources please place an order. The downloadable resources are available on our Resource Ordering page. Contact InformationHealth Care provider/ Clinic Name(Required) Email(Required) Main Contact Name(Required) PhoneIs this order for mail or pickup?(Required) Mail Pickup Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country General Age-Friendly Sarnia-Lambton PosterSelect Quantity To Order255075100125Infectious Disease Prevention & ControlTuberculosis RulerSelect Quantity To Order15101520Maternal/Child Health Post Card: HBHC Ask a Public Health NurseSelect Quantity to Add to Order255075100Brochure: Clinical & Family ServicesSelect Quantity to Add to Order255075100VaccinesVaccine Reporting Resource – Business Card SizeSelect Quantity to Add to Order255075100Poster Immunization Through the LifespanSelect Quantity to Add to Order12345Poster: HPV Burden of DiseaseSelect Quantity to Add to Order12345Poster: Vaccine Promotion/ Reporting Poster- Tomorrow Starts TodaySelect Quantity to Add to Order255075100Handout: HPVSelect Quantity to Add to Order255075100Handout: Grade 9 HPV Start the Discussion GuideSelect Quantity to Add to Order255075100Yellow Immunization CardsSelect Quantity to Add to Order255075100Sticker: Yellow Immunization Card Report VaccinesSelect Quantity to Add to Order255075100Min-Max ThermometerSelect Quantity to Add to Order12Vaccine CoolerSelect Quantity to Add to Order12Water BlanketSelect Quantity to Add to Order12Ice PackSelect Quantity to Add to Order12Sticker: "Do Not Unplug"Select Quantity to Add to Order1234Sticker: "How to Monitor Your Refrigerator Temperature"Select Quantity to Add to Order1234Sticker: "Protect Your Vaccines – Protect Your Patients"Select Quantity to Add to Order1234Sticker: "STOP! "Select Quantity to Add to Order1234Sticker: "This Cooler Contains Perishable Vaccines DO NOT FREEZE"Select Quantity to Add to Order12Vaccine Refrigerator Maintenance Log Book (English)Select Quantity to Add to Order12Vaccine Storage and Handling Guidelines Booklet (English)Select Quantity to Add to Order12Vaccine Temperature Log Book (English)Select Quantity to Add to Order12 The information in this form is being collected, used, and disclosed subject to the Health Protection and Promotion Act (Ontario) or the Personal Health Information Protection Act, 2004 (Ontario). Personal information contained on this form is collected for the purposes of resource ordering from Lambton Public Health. Any information you share will be used only for the intended purpose for which it was provided. Any questions regarding the collection, use and disclosure of this information may be directed to Lambton Public Health at 519-383-8331 or toll free 1-800-667-1839.