Skip to Main Content
Bookmark and Share print small medium large 
The following is an index of forms for this department available in PDF format and/or Submittable Online.
Search Forms:


     
A
Alzheimer's Special Authorization Form
Health PEI

(21 KB)
Amateur Sport High Performance/Aspiring Athlete, Coach, Official Assistance Application Form
Health and Wellness

(online)
Amend or Alter a PEI Statement of Birth Application
Health and Wellness

(100 KB)
Ankylosing Spondylitis Special Authorization Form
Health PEI

(102 KB)
Anti-TNF Agents for Psoriasis Special Authorization Request Form
Health PEI

(106 KB)
Application For a Search of Record
Health and Wellness

(96 KB)
APPLICATION FOR OWNERSHIP REGISTRATION OF RADIATION EQUIPMENT
Health and Wellness
Download
(External Site)
Application for Swimming Pool Operating Permit
Health and Wellness

(84 KB)
Application to Operate a Food Premise
Health and Wellness

(102 KB)
Athlete's Declaration High Performance/Athlete Assistance Program Expense Form
Health and Wellness

(100 KB)
Audiology Adult Case History
Health PEI

(493 KB)
Audiology Adult Referral Form
Health PEI

(101 KB)
Audiology Child (Paediatric ) Referral Form
Health PEI

(173 KB)
Audiology Child (Paediatric) Case History
Health PEI

(190 KB)
B
Birth Record Application
Health and Wellness

(270 KB)
C
Cancer Drug Special Authorization Form 1 - Filgrastim, Capecitabine, Imatinib, Dasatinib, Erolotinib, Sunitinib, Pazopanib, fludarabine, Sorafenib, Crizotinib, Tretinoin, Nilotinib, Temozolomide, Lenalidomide
Health PEI

(123 KB)
Cancer Drug Special Authorization Form 2 - Vemurafenib, Abiraterone, Enzalutamide
Health PEI

(87 KB)
Carte santé personnelle formulaire de demande
Health PEI

(65 KB)
Catastrophic Cost Drug Program Application Form
Health PEI

(261 KB)
Clopidogrel Special Authorization Request Form
Health PEI

(19 KB)
Crohn's Disease Special Authorization Form
Health PEI

(104 KB)
D
Dabigatran, Rivaroxaban, Apixaban Special Authorization Request Form
Health PEI

(67 KB)
Delayed Registration of Birth, Marriage or Death Application
Health and Wellness

(87 KB)
Demande de remplacement de la carte-santé
Health PEI

(192 KB)
Dentaire - Programme de soins dentaires des enfants de l’Î.-P.-É Demande d'exemptionde contribution parentale
Health PEI

(140 KB)
Dentaires - Déclaration Programme de soins dentaires pour les enfants de l’Î.-P.-É
Health PEI

(136 KB)
Dental - Application for Orthodontic Treatment Funding for Cleft Palate Patients
Health PEI

(129 KB)
Dental - Declaration PEI Children's Dental Care Program Dental Treatment Services
Health PEI

(136 KB)
Dental - PEI Children's Dental Care Program Application for Exemption From Parental Contribution
Health PEI

(138 KB)
Diabetes 24 hour blood glucose record for shift workers
Health PEI

(48 KB)
Diabetes Home Blood Glucose Monitoring
Health PEI

(227 KB)
Directive relatie aux soins de santé
Health PEI

(185 KB)
DPP4/SGLT2 Special Authorization Form
Health PEI

(29 KB)
E
Emergency Health - Special Patient Program
Health PEI

(94 KB)
Emergency Medical Technician (EMT) Continuing Education Units Form
Health PEI

(49 KB)
Emergency Medical Technician (EMT) Emergency Call-Out Form
Health PEI

(35 KB)
Emergency Medical Technician (EMT) License Application and Instructions
Health PEI

(78 KB)
Emergency Medical Technician (EMT) National Licensing Examination Registration Form
Health PEI

(37 KB)
Emergency Medical Technician (EMT) Verification of Registration Form
Health PEI

(23 KB)
Enfuvirtide Special Authorization Request Form
Health PEI

(20 KB)
Erythropoietin Program Approval Form
Health PEI

(22 KB)
Esbriet Special Authorization Request Form
Health PEI

(73 KB)
Eye See ... Eye Learn Program - Application for Co-Pay Reimbursement
Health PEI

(70 KB)
Eye See ... Eye Learn Program - Declaration Form
Health PEI

(70 KB)
F
Family Health Benefit Program - Application Form
Health PEI

(329 KB)
FIT Home Screening Test Request Form
Health PEI

(513 KB)

(online)
Food Hygiene Training Program Registration Form
Health and Wellness

(1292 KB)
G
Generic Drug Program Application
Health PEI

(378 KB)

(external)
H
Health Card - Personal Health Card Application Form
Health PEI

(99 KB)
Health Card - Request for Replacement of Health Card
Health PEI

(200 KB)
Health Care Directive
Health PEI

(238 KB)
Hepatitis C Program Form
Health PEI

(57 KB)
High-Cost Drug Program Application Form
Health PEI

(41 KB)
Home Care Referral Form
Health PEI

(48 KB)
Home Oxygen Program - Application Form
Health PEI

(77 KB)
I
Influenza Immunization Clinic Form 2015/2016
Health PEI

(205 KB)
Insulin Pump Program - Family Contribution Assessment and Release of Information
Health PEI

(171 KB)
L
liste de médicaments
Health PEI

(461 KB)
Long Acting Insulin Analogues Special Authorization Request Form
Health PEI

(35 KB)
Low Molecular Weight Heparin Special Authorization Form
Health PEI

(34 KB)
M
Marriage and Death Records Application
Health and Wellness

(270 KB)
Medication List
Health PEI

(707 KB)
Mental Health - Community Mental Health Adult Services Referral
Health PEI

(122 KB)
Milk Processing Application
Health and Wellness

(47 KB)
Multiple Sclerosis Medications Program Medical Screening Form
Health PEI

(119 KB)
Multiple Sclerosis Medications Program Patient Application Form
Health PEI

(33 KB)
O
Opening a new food premise
Health and Wellness

(185 KB)
Out-of-Province Travel Support Application Form
Health PEI

(509 KB)

(online)
Out-of-Province Travel Support Multiple Trips Application Form
Health PEI

(487 KB)

(online)
P
Parental Consent for Influenza Immunization
Health PEI

(108 KB)
PEI Marriage Commissioner Licence Application
Health and Wellness

(376 KB)
PEI Provincial Patient Registry Application Form
Health PEI

(605 KB)

(online)
PEI Reproductive Care Resource List
Health PEI

(76 KB)
PEI Reproductive Care Resources: Order Sheet
Health PEI

(59 KB)
Pharmaceutical Information Program - Application for Correction
Health PEI

(24 KB)
Pharmaceutical Information Program - Application for Disclosure to Individual
Health PEI

(23 KB)
Pharmaceutical Information Program - Application for Password
Health PEI

(23 KB)
Pharmaceutical Information Program - Application for Release of Information for Purpose of Reports or Planning
Health PEI

(26 KB)
Pharmaceutical Information Program - Application for Release of Information for Research Purposes
Health PEI

(27 KB)
Pharmaceutical Information Program - Confidentiality Undertaking
Health PEI

(19 KB)
Pharmaceutical Information Program - Confirmation of Confidentiality Undertaking
Health PEI

(20 KB)
Programme de financement des pompes à insuline de l’Î.-P.-É.
Health PEI

(944 KB)
Provincial Cervical Cancer Screening Service Appointment Request Form
Health PEI

(656 KB)

(online)
Psoriatic Arthritis Special Authorization Form
Health PEI

(97 KB)
R
Renew PEI Marriage Commissioner Licence Application
Health and Wellness

(210 KB)
Request for Vital Statistics Data
Health and Wellness

(275 KB)
Rheumatoid Arthritis Special Authorization Form
Health PEI

(108 KB)
S
Standard Special Authorization Form
Health PEI

(33 KB)
T
Tanning Facility Registration Form
Health and Wellness

(53 KB)
Transplant Surgery Out-of-Province Travel and Accommodation Assistance Expense Claim Form
Health PEI

(26 KB)
Trousse du TIF – Formulaire de demande
Health PEI

(526 KB)

(online)
V
Volunteer Services Application Form - Hillsborough Hospital
Health PEI

(62 KB)
Volunteer Services Application Form - Prince County Hospital
Health PEI

(80 KB)
Volunteer Services Application Form - Queen Elizabeth Hospital
Health PEI

(44 KB)
Y
Year 1 - PSO Report
Health and Wellness

(119 KB)
Year 2 – Athlete Selection
Health and Wellness

(207 KB)
Year 3 – Rehearsal for Canada Games
Health and Wellness

(57 KB)
Year 4 – Canada Games Sport Plan
Health and Wellness

(159 KB)
back to top