Please refer to Alberta Health Services' processes for communicable disease assessments.

Personal details
Address and contact details
Employment details

Include volunteer or physician, etc.

Please upload all of your immunization records as a single file, including any applicable titer testing history (laboratory testing to verify immunity). Vaccination records must contain two personal identifiers, such as legal name and date of birth.

If you would rather not upload at this time, please email your records to occhealthnurse@covenanthealth.ca.


One file only.
10 MB limit.
Allowed types: jpg, jpeg, pdf.

Collection of personal information – notification statement:
The personal information requested on this form is collected under the authority of Section 4(c) of the Alberta Protection of Privacy Act (POPA) and will only be used for the purpose of tracking, follow up and communications regarding your request. For information about the collection and use of this information, contact the Covenant Health Information and Privacy Office at One Twelve Campus, 10130 112 Street NW, Edmonton, AB, T5K 2K4, Tel. 1.866.254.8181.