Forms

Gender Confirming Surgery Prior Approval Request Form

Medical Affairs Administration, Primary Care and Chronic Disease
September 9, 2024

Gender confirming surgery is insured under PEI Medicare when prior authorization has been obtained from Health PEI. Your family physician or nurse practitioner will need to complete this form and provide the necessary attachments to Health PEI's Out-of-Province Coordinator.
 

Medical Assistance in Dying (MAiD) Patient Request and Consent Form

Community Specialist Services
September 9, 2024

This consent form is required to participate in the MAiD process. Individuals are encouraged to complete the consent form in advance of their assessment with the MAiD provider. Consent can be withdrawn or cancelled at any time.

For more information, visit Medical Assistance in Dying.
 

Provincial Medical Assistance in Dying (MAiD) Clinic Referral and Intake Form

Community Specialist Services
September 9, 2024

This form is to be completed by your health care provider.  
 

Agri-Food Growth Application Form

Agriculture Industry Development
September 4, 2024

Application form for the Agri-Food Growth Program 2024-2025

FFP: Analytical Laboratory Reimbursement Form

Sustainable Agriculture
September 3, 2024

Appendix A: Reimbursement form for the Future Farmer Program: Analytical Laboratory Component

Immunization and Mantoux Requirements Form

Health and Wellness
August 29, 2024

PEI Birth Record Application

Vital Statistics
August 28, 2024

To apply for a birth record, enter the birth information of the person in whose name the certificate will be issued and the names of both parents and their place of birth. A birth certificate can only be issued if the birth occurred and is registered in the province and the birth information submitted on this form agrees with records filed at Vital Statistics.

Psoriatic Arthritis Special Authorization Request Form

Pharmacare Program
August 28, 2024

Special authorization request form to be completed by your physician or diagnosing specialist.

 

General Inquiries

Contact Government
or use the Feedback tab to share your comments and feedback