To order potassium iodide (KI) pills for your home or business, please complete the form below.
Are you submitting an order for your home or a place of business? Please select Home Business
How many adults and children are there in your household?
Adults 18+ Please enter a number between 0 and 10.
Children 0–17 Please enter a number between 0 and 10.
Business name
How many employees are working at this location? Please enter only numbers.
First name
Last name
Street address
City
Postal code Please enter a valid postal code. Your home or business is not within the eligible zone of the Pickering or Darlington stations. There is no need for you to have KI pills on hand.
Phone number Please enter only numbers.
Email address Please enter a valid email address.
I am 18 years of age or older.
Reason for your order Please select I have not received any tablets I did not receive enough tablets during the original distribution The tablets I was given are damaged or lost Other
Please explain your reason
I have read and understood the Privacy Policy and Terms and Conditions of use for this site. If submitting for a place of business, I confirm that I am authorized to act on behalf of that business.
* Required
Please include all required fields to submit.
Thank you for your participation in the KI distribution program.