The form is used to refer a child/youth to tertiary medical consultation services at CPRI. This is a one-time developmental behavioural consultation with a CPRI paediatrician or a psychiatrist. It can also include diagnostic opinion/interdisciplinary ASD diagnostic assessment. Referrals will only be accepted from a medical specialist (e.g. paediatrician, psychiatrist, neurologist, geneticist). All CPRI recommendations are provided to the referring specialist.
Form used so patient can submit out of country medical receipts
The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
You may use this application form to apply for the Ontario Seniors Dental Care Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
You may use this application form to apply for the Ontario Seniors Dental Care Program if you do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
This is a surety bond template, which is to be used in the context of temporary help agency and recruiter licensing under the Employment Standards Act, 2000.
This form is used for registering a facility, updating or revoking an existing registration, the identification of a licensed laboratory or to provide notice of reduce lead sampling.
To allow individuals to apply for religious/conscience exemptions for immunizations
The purpose of this Application Form is to provide MNRF with the necessary information to process and review a request for a new (Type A), revised (Type B) or renewed (Type C) license for Cage Aquaculture Facilities.
Application Form for entry into the Ontario Home Energy Audit Program for Corporate Owned Residential Properties. Homeowners are required to complete this form with a licensed Energy Advisor during their home energy audit to be eligible for an audit grant. For more information, visit
www.ontario.ca/homeneergy
The use of this aid is voluntary. It is being provided to assist you in maintaining records for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting a Waiver of Final Consent. The Waiver of Final Consent is ONLY applicable for individuals whose natural death is reasonably foreseeable (RFND).
The Small Drinking Water System Identification form is to be used by owners of small drinking water systems to notify in writing the medical officer of health in the health unit where their system is located before supplying drinking water to users of the system following construction or alteration of the small drinking water system or following a shut-down of the system that lasts longer than seven days.
A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.
Used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.
The use of this aid is voluntary. It is being provided to assist you in maintaining records for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting Advance Consent for MAID Self-Administration.
Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service
Application Form for entry into the Ontario Home Energy Audit Program. Homeowners are required to complete this form with a licensed Energy Advisor during their home energy audit to be eligible for an audit grant. Please visit the program website at
www.ontario.ca/homeenergy for more information.
