This secure form is to be completed by people living in Simcoe Muskoka who have not updated their health card with their chosen name but would like to have their proof of vaccine certificate reflect their chosen name.
Please note: Only chosen name change requests for residents of Simcoe Muskoka will be processed. Please contact your local public health unit for assistance if you are not a resident of Simcoe Muskoka.
You will need to upload at least two valid pieces of documentation to process the name change on your vaccine certificate (one with chosen name and one with former name). The combination of documents submitted must include name, birth date and photo ID (for those 18 years and older).
The following are types of documentation that will be accepted:
- Driver’s license
- Birth certificate
- Passport
- Piece of registered mail
- Pay stub
- Student card
- Library card
- Club or organization ID cards
- Government issued identification from other jurisdictions including foreign passports, other provincial or territorial health cards, or driver’s license.
If you do not have identity documentation or are unable to provide verification of primary place of residence, you can submit a letter from a community organization, your school, or your medical provider to verify your identity.
If you do not have access to a device to upload the documentation, please call us at 705-721-7520 or 1-877-721-7520 Monday to Friday 8:30 a.m. to 4:30 p.m. and ask to speak to the Immunization Program at ext. 8827 and we will make arrangements for you to meet with a nurse at your closest health unit office to submit your documentation.