Forms
Provincial Medical Assistance in Dying (MAiD) Clinic Referral Form
Published date:
July 2, 2026
This form is to be completed by your health care provider.
General Inquiries
PO Box 2000
Charlottetown, PE C1A 7N8
Phone: 902-368-6130
Fax: 902-368-6136
If you are experiencing a medical emergency, call 9-1-1 or go to the nearest emergency department.
If you are unsure what to do about a health issue or if you need health information,
call 8-1-1.
