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Emergency Medical Technician (EMT) License Application and Instructions
2019-12-12
In order to practice Emergency Medical Technology in Prince Edward Island, all applicants must hold current registration with the EMS Board of Prince Edward Island. Use the guide in this document to identify the right application type.
Community Mental Health and Addictions - Adult Services Referral Form
2019-11-12
Your doctor, nurse practitioner or other service provider can refer you for adult services with community mental health and/or addictions services.
Cardiac Rehab Referral Form
2019-10-30
Your physician or nurse practitioner can refer you to the , Cardiac Rehab Program, by submitting this referral form. An exercise stress test , must, be sent in with your referral. If you meet the inclusion criteria for the program, you will be contacted for an assessment appointment. For more...
Pulmonary Rehab Referral Form
2019-10-30
Your physician or nurse practitioner can refer you to the , Pulmonary Rehab Program, by submitting this referral form. If you meet the inclusion criteria for the program, you will be contacted for an assessment appointment. For more information, visit the Cardiac and Pulmonary Rehab Programs .
Influenza Immunization Clinic Registration Form
2019-10-07
To receive a flu vaccination, you must complete a registration form. Complete the top section of this form and bring it with you to a vaccination clinic.
Immunization Report Form (email)
2019-08-30
The 2019-2020 report form for recording and reporting immunizations by email to the Chief Public Health Office. Immunizers are encouraged to report electronically, if possible. Contact the Chief Public Health Office at (902) 368-4996 if you have questions about your reporting requirements.
Immunization Report Form (printable) 2019
2019-08-30
The 2019-2020 printable report form for recording and reporting immunizations by fax or mail to the Chief Public Health Office. Immunizers are encouraged to report electronically, if possible. Contact the Chief Public Health Office at (902) 368-4996 if you have questions about your reporting...
Apixaban, Dabigatran, Edoxaban, Rivaroxaban Special Authorization Request Form
2019-07-26
Special authorization request form to be completed by your physician or diagnosing specialist.
Emergency Medical Technician (EMT) Verification of Registration Form
2019-07-10
Complete this form to verify your registration with the appropriate regulatory body. Send forms to each regulatory body where registered and/or licensed currently or previously. Additional copies of this form must be used if you have been registered in more than one province/territory.
Dental Care Program for Children - Declaration Form
2019-05-17
As part of the application process to apply for dental public health services for your child, you must complete and sign a declaration form to declare that your child is, not, covered under a private dental insurance plan.