Forms

Ontario Drug Benefit Program (ODB)

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.

4846-87 Request for Aldurazyme® Fill & Print
4652-87 Request for Myozyme® Fill & Print
4591-87 Request for Elaprase® Ontario Public Drug Programs (OPDP) Fill & Print
4551-87 Application and Consent for the Inherited Metabolic Diseases (IMD) Program Fill & Print
4645-87 Respiratory Syncytial Virus (RSV) Prophylaxis for High Risk Infants Program Enrolment/Request Form Fill & Print
4423-87 Notification for Change of Information for Trillium Drug Program View & Print
4406-87 Request for an Unlisted Drug Product- EAP Fill & Print
4247-87

"Guide" for the Co-payment Application for Seniors

- Notice to Recipients of Ontario Drug Benefits

Mail completed Co-payment Applications to the following address for processing :

Drug Benefit Programs- MOHLTC
P.O. Box 384
Etobicoke ON M9A 4X3

Questions regarding the Co-payment Application form/guide should be directed as follows :

In Toronto, call 416-503-4586
Toll-free: 1-888-405-0405 or
E-mail : seniors@ontariodrugbenefit.ca

View & Print
3693-87 Application for Ontario Drug Benefits
Trillium Drug Program Guide (25 pages)

- Notice to Recipients of Ontario Drug Benefits

Fill & Print
View & Print
3233-87 Co-payment Application for Seniors View & Print
3057-87 Nutrition Products Paper copy only
View & Print
2784-87 Drug Benefit Claim/Reversal Fill & Print
2772-87 Special Authorization (Allergen) Paper Copy Available
View Only

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