Report Changes to your Ontario Health Card Information

Contact Information

* First name

* Last name

* Reason for submission Select one... Change in first, middle or last name Change of address New Ontario health card number

* Phone number
xxx-xxx-xxxx

* Email

* Gender Select one... Female Male Non-binary / third gender Prefer not to say Unknown Other

* Date of birth Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day 12345678910111213141516171819202122232425262728293031 Year 2024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886188518841883188218811880187918781877187618751874

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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 Select one... Driver's licence number Passport number Non-Ontario health card Other

* Legal name identification image

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Chosen name identification

* Chosen name updated First name
Middle name
Last name

Type of identification Select one... Driver's licence number Passport number Non-Ontario health card Other

* 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.