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Forms

Physician Outreach Program Billing Form - Monthly [PDF]
Confirmation of Payment Instruction [PDF]
Statement of Expenses  [PDF]
Free Tuition Program Return-of-Service Agreement [PDF]
Free Tuition Program Consent to Collection and Disclosure of Personal Information
Free Tuition Program Addendum to the Return-of-Service Agreement  [PDF]
Applications
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For more information

For more information on the Underserviced Area Program, please call
705 564-7280, toll free 1-866-727-9959, fax 705 564-7493 or write to :

Ministry of Health and Long-Term Care
Primary Health Care Team
Underserviced Area Program
159 Cedar Street, Suite 402
Sudbury  ON  P3E 6A5

 
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