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Diabetes Referral Form
2024-04-02
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program.
Cardiac Rehab Referral Form
2022-01-19
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...
Pulmonary Rehab Referral Form
2022-01-19
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...
Demande de financement de traitement d’orthodontie pour les patients ayant une fissure palatine
2021-09-02
Veuillez remplir le présent formulaire pour demander un appui financier pour le traitement orthodontique d’une fissure palatine pour les enfants qui naissent avec cette malformation.
Programme de financement des pompes à insuline de l’Î.-P.-É. : Formulaire d’évaluation de la contribution du client ou de la famille et de consentement à la divulgation de renseignements
2021-01-28
Remplissez ce formulaire pour vous inscrire au Programme de financement des pompes à insuline.
Home Care Referral Form
2019-01-28
Complete and submit this referral form to your local Home Care office to access services. A referral can be made by yourself, your family, care provider, or family doctor. Services are provided based on assessed need for a defined period of time.
Child Audiology Referral Form
2019-01-15
Complete this form to request audiology services for children.