• Contact Us
  • Français

Search and menus

  • Search and menus
Prince Edward Island
  • Site Search
  • Departments
Select a department
  • Agriculture and Land
  • Economic Growth, Tourism and Culture
  • Education and Lifelong Learning
  • Environment, Energy and Climate Action
  • Finance
  • Fisheries and Communities
  • Health and Wellness
  • Justice and Public Safety
  • Social Development and Housing
  • Transportation and Infrastructure

Topics menu

  • Home
  • About PEI
    • About PEI Topics
      • History of Prince Edward Island
      • Immigrate
      • Move to PEI
      • Learn about PEI
      • Island Life during COVID-19
      • PEI Success
      About PEI Services
      • Advisories
      • Events
      • Maps of PEI
      • News
      • Search the Archives Online
    • See more About PEI topics
  • Residents
    • Resident Topics
      • Environment and Land
      • Health
      • Jobs
      • Home and Property
      • What you need to know about COVID-19
      • Tax Administration and Property Records
      • Protect Yourself and Others from COVID-19
      Resident Services
      • Forms
      • Motor Vehicle Registration Renewal
      • Publications
      • Register for a Family Doctor
      • Get a Driver's License
      • Report a Road or Traffic Problem
      Resident Audiences
      • Youth
      • New Residents
      • Family
      • Seniors
    • See more Residents topics
  • Business
    • Business Topics
      • Agriculture, Natural Resources and Industry
      • Business Start-up and Entrepreneurship
      • HR: Hiring, Managing and Training
      • Loans and Incentives
      • Productivity and Innovation
      • Permits, Licensing and Business Tax
      • COVID-19 for Workers and Business
      Business Services
      • Apply for Business Development Assistance
      • Apply for License to Operate a Food Premises
      • View Tender Opportunities
      Business Segments
      • Exporting from PEI
      • Investing in PEI
      • PEI Economy
      • Supporting Business
    • See more Business topics
  • Government
    • Government Topics
      • Agencies, Boards and Commissions
      • Departments
      • Executive Council Office
      • Health PEI
      • Innovation PEI
      • Municipal Governments
      • Premier of Prince Edward Island
      • Publications
      • PEI's Response to COVID-19
      • SkillsPEI
      Government Services
      • Apply to Engage PEI
      • Employee Directory
      • Legislation
      • News
      • Orders in Council
      • Public Disclosures
      • Request for Information (FOIPP)
      • Royal Gazette
    • See more Government topics
  • Online Services

Search

Feedback
Go to the COVID-19 Search to search all COVID-19

Go to the News search to search all news

Displaying 1 - 10 of 11.

Results

Goals of Care Form

https://www.princeedwardisland.ca/sites/default/files/forms/goals_of_care_form.pdf
2016-11-23
The Goals of Care form is used by your health care provider after speaking with you and your substitute decision maker. These instructions that will guide your health care team about the general focus of your care and where you might want that care. Your health care provider will write your Goals...
Microsoft Word - Goals of Care Form.docx GOALS OF CARE Is there an existing Health Care Directive on file? No Yes (If yes, it shall guide further discussions as an indication of the Patient/Client/Resident’s wishes at time...

Blood Glucose Record - Travelling Across Time Zones

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record_-_across_time_zones.pdf
2016-04-21
Use this to record your blood glucose levels while you are travelling across time zones.
H:\Martha's Files\Provinical Diabetes Program\Provincial Team Meeting\website design\FAQ section\Diabetes and Traveling Across Diabetes and Traveling Across Time Zones Leaving Insulin Food Returning Insulin Food West: Usual dose + (...

Blood Glucose Record - 24 Hour

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record_-_24_hour.pdf
2016-04-21
Use this to record your blood glucose levels over a 24 hour period.
24 Hour Blood Glucose Record Patient Name:_______________________________________________________________________________________________ Phone: _______________________________________Email:_______________________________________ Day/ Date ____ 12AM...

Blood Glucose Record

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record.pdf
2016-04-21
Use this to record your blood glucose levels.
C:\Documents and Settings\wematthews\Desktop\Martha\Insulin BG Monitoring.wpd Home Blood Glucose Monitoring Provincial Diabetes Program January 2009 Name:   Phone:   Insulin Dose...

FIT Home Screening Test Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/fit_home_screening_test_request_form.pdf
2016-03-03
Complete this FIT Home Screening Test Request form if you are, 50-74 years of age, and are of, average risk for colorectal cancer, . 
Microsoft Word - FIT June 2015_1.docx FIT Home Screening Test Request Form Thank you for your interest in a home screening test. The PEI Colorectal Cancer Screening Program is for Islanders aged 50-74 years of age who are of average risk for...

Adult Audiology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/adult_audiology_case_history.pdf
2016-01-07
Complete this form to provide information on your hearing and submit with your Audlt Audiology Referral Form.
Audiology 161 St. Peter’s Road PO Box 2000 Charlottetown, PE C1A 7N8 T: 902-368-5807 / F:902-620-3195 Email: speechandhearing@ihis.org Audiologie 161, chemin St. Peter’s C.P. 2000, Charlottetown...

Child Audiology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/child_audiology_case_history.pdf
2016-01-07
Complete this form to provide information on your child's hearing and submit with your Child Audiology Referral Form.
Audiology 161 St. Peter’s Road PO Box 2000 Charlottetown, PE C1A 7N8 T: 902-368-5807 / F:902-620-3195 Audiologie 161, chemin St. Peter’s C.P. 2000, Charlottetown Île-du-Prince-Édouard, C1A...

Eye See...Eye Learn Co-pay Reimbursement Application

https://www.princeedwardisland.ca/sites/default/files/forms/eye_see_eye_learn_copay_reimbursement_application.pdf
2016-01-07
Complete and submit an application for co-pay reimbursement for the Eye See... Eye Learn program if your optometrist is unable to bill your insurance provider directly.  You will have to pay up front and be reimbursed for the remaining amount.  
DRAFT PEI Eye See Eye Learn Program Application for Co-Pay Reimbursement Public Health & Children’s Developmental Services Speech Language Pathology, Audiology and Eye See Eye Learn Programs 161 St. Peters Road PO Box 2000 Charlottetown, PE C1A 7N8...

Eye See...Eye Learn Program Declaration

https://www.princeedwardisland.ca/sites/default/files/forms/eye_see_eye_learn_program_declaration.pdf
2016-01-07
Complete the Eye See... Eye Learn Program Declaration if you do not have private insurance.  Your optometrist will not ask you to pay for the exam and glasses, if required, as they are covered by Health PEI and the PEI Association of Optometrists.
Declaration PEI Eye See Eye Learn ProgramPublic Health and Children’s Developmental ServicesSpeech Language Pathology, Audiology and Eye See Eye Learn Programs 161 St. Peters Road PO Box 2000 Charlottetown, PE C1A 7N8 Telephone: (902) 368-5819 Fax: (...

Orthodontic Treatment Funding for Cleft Palate Patients Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/orthodontic_treatment_funding_for_cleft_palate_patients_application_form_1711.pdf
2016-01-07
Complete this form to apply for orthodontic treatment funding for children who are born with cleft palate. Depending on your family income and number of children in the family, funding will cover 50, 75 or 100 per cent of the cost of orthodontic treatment provided by an orthodontist in Prince...
J:\CLEFT PALATE\POLICY\APPLICAT.FRM Application for Orthodontic Treatment Funding for Cleft Palate Patients Please fill out section A and ask the orthodontist or pediatric dentist to fill out section B. If you are applying for additional funding...
  • Show more

Content Type

  • Remove Form filter Form

Category

  • Remove Health filter Health
    • Medical Professional 1 Apply Medical Professional filter

Service Category

Departments and Agencies

  • Remove Health PEI filter Health PEI
    • Remove Family and Community Medicine and Hospital Services West filter Family and Community Medicine and Hospital Services West
      • Public Health and Children's Developmental Services 6 Apply Public Health and Children's Developmental Services filter
      • Primary Care and Chronic Disease 4 Apply Primary Care and Chronic Disease filter
      • Home Care, Palliative Care and Geriatric Care 1 Apply Home Care, Palliative Care and Geriatric Care filter

Published Date

  • Remove 2016 filter 2016
    • November 2016 1 Apply November 2016 filter
    • April 2016 3 Apply April 2016 filter
    • March 2016 1 Apply March 2016 filter
    • January 2016 6 Apply January 2016 filter

General Inquiries

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

About this site

What you need to know about COVID-19

Wordmark of Government of Prince Edward Island
Contact Us
Access PEI Locations
Employee Directory

 

  • Calendar of Events
  • News
  • Publications
  • Facebook
  • Subscribe
  • Twitter
  • Flickr
  • Youtube
  • Linkedin

© 2021 Government of Prince Edward Island

  • Privacy
  • Disclaimer
  • Accessibility