Register for Online Ordering
Register for Online Ordering
As a minimum please complete all required fields and then click Submit.

Provider type:
Name of organisation/practice:
Delivery Address:
Delivery Address 1:
Delivery Address 2:
Delivery Suburb:
Delivery Postcode:
Postal Address: Same as delivery address
Postal Address 1:
Postal Address 2:
Postal Suburb:
Postal Postcode:
   
Email for vaccine delivery communication:
Telephone:
Fax:
Declaration

I acknowledge that as a requirement to receive government funded vaccines:
This facility complies with cold chain recommendations in the National Vaccine Storage Guidelines - Strive for Five.  Yes  No
All funded vaccines will be administered according to SA Health's vaccine eligibility criteria and the South Australian Immunisation Program Schedule.  Yes  No
Each funded vaccine dose administered in this facility will be notified to the Australian Immunisation Register (AIR) and/or the National HPV Vaccination Program Register (as required). Click here to register for AIR access.  Yes  No
All employees submitting information to the Australian Immunisation Register are provided appropriate training or guidance to ensure accuracy of data submission. Click here to access eLearning resources.  Yes  No


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