Public Information
Forms
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 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.
| 1429-67 | Insulin Syringes for Seniors Program | View only |
| 1945-67 | Ostomy Grant Applicant Information | View & Print |
| 1976-67 | EA Equipment/Supply Authorization | View only |
| 2045-67 | Release of Information | Fill & Print |
| 2196-67 | Application for Funding Mobility Devices | Fill & Print |
| 2451-67 | Home Oxygen Program | View only |
| 2961-67 | Request for Special Approval - Orthotics and Prosthetics | Fill, Print & Save |
| 3183-67 | Application for Limb Prosthesis Funding Assistance | View only |
| 3224-67 | Hearing Device Application | View only |
| 3414-67 | Hearing Aid Dispenser Application | Fill & Print |
| 4392-67E | Breast Prosthesis Grant Application/Information | Fill & Print |
| 4446-67E | Application for Funding Insulin Pumps and Supplies for Children | Fill & Print |
| 4537-67E | Application for Funding Insulin Pumps and Supplies for Adults | Fill & Print |
For More Information
Call ServiceOntario, Infoline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559. In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm
If you are a member of the media, call Communications and Information Branch at 416-314-6197 or visit our News Room section.
