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Ontario Ministry of Health and Long-Term Care




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Index

Forms and Applications : Assistive Devices

Forms are listed alphabetically in Portable Document Format (PDF). To view and print the forms, you need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the (External) Adobe Web site .

Click on the form title to open the form. You can fill-in the form on your screen and print it, or use the disk icon on the Reader toolbar to save a blank copy of the form to your computer. Filled-in forms cannot be saved.

To print, use the printer icon on the Reader toolbar . For form sizes larger than 8.5 x 11 inches, check the Fit to Page box in the print menu window. See the Forms and Applications main menu page for detailed instructions .


2961-67
(External) Request for Special Approval - Orthotics and Prosthetics
FILL & PRINT
1429-67
(External) Insulin Syringes for Seniors Program
VIEW ONLY
1945-67
(External) Ostomy Grant Applicant Information
VIEW & PRINT
1976-67
(External) EA Equipment/Supply Authorization
VIEW ONLY
2045-67
(External) Release of Information
FILL & PRINT
2196-67
(External) Application for Funding Mobility Devices  
FILL & PRINT
2451-67
(External) Home Oxygen Program
VIEW ONLY
2961-67
(External) Request for Special Approval - Orthotics and Prosthetics
FILL & PRINT
3183-67
(External) Application for Limb Prosthesis Funding Assistance
VIEW ONLY
3224-67
(External) Hearing Device Application
VIEW ONLY
3414-67
(External) Hearing Aid Dispenser Application
FILL & PRINT
4392-67E
(External) Breast Prosthesis Grant Application/Information  
FILL & PRINT
4446-67E
(External) Application for Funding Insulin Pumps and Supplies for Children
FILL & PRINT
4537-67E
(External) Application for Funding Insulin Pumps and Supplies for Adults
FILL & PRINT


For more information

Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm
  

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