Please be sure to have all supporting documents with you.

A. Personal information

All applicants must complete this section.

If your mailing address is a P.O. Box, Rural Route, or General Delivery, then you must provide your civic address in the residence address section. You will be asked to provide a document that proves your primary place of residence is in Ontario. Please refer to the Ontario Health Insurance Coverage Document List for acceptable documents that can be presented for residency.

B. New or Returning Residents of Ontario

If you are new to Ontario or you are returning from an absence from Ontario, complete this section.

C. Agreement

If you are over the age of 16 you must read and sign this section. Your photograph will be taken and will appear on your Health Card. A parent or legal guardian may sign for applicants under the age of 16 years.

Note: Health Cards for children under 15 ½ years of age:

  1. Children under 15 ½ years of age will not have a photograph taken therefore they do not need to be present to be registered. A parent or legal guardian should bring the child’s original documents and this form to a ServiceOntario / Health Card Services (OHIP) Office.

  2. If you have a child who will be turning 16 within the next 6 months, he/she can obtain a photo Health Card and will need to apply in person.

Government of Ontario


Registration for Ontario Health Insurance Coverage

If you are new or returning to Ontario, complete sections A, B, and C.
If you are renewing your photo Health Card, complete sections A and C.

Refer to the Ontario Health Insurance Coverage Document List for the list of documents you will need to present with your application.
Please print and use a blue or black pen.

Facility Use Only


A. Personal information



Official language preference?


Have you ever had an Ontario Health Number?


Home Telephone Number

Work or other Telephone Number
Mailing Address

Residence address
(if different from above)

Province ON

Country CANADA

B. Section to be completed only by new or returning residents

Where did you move from?

How long do you plan to live in Ontario?


If you moved from another part of Canada, were
you covered by a government health plan?


Are you a Canadian citizen returning to Canada?


Are you an immigrant returning to Canada?


Are you a new immigrant?


Have you recently left the Canadian Forces?


Have you recently been released from a Federal penitentiary?


Are you the spouse or dependant of a Regular Force member
of the Canadian Forces?


Are you a reservist returning from an out-of-country posting?


Are you the spouse or dependant of a reservist currently
deployed by the Canadian Forces into active service?


C. Agreement

I confirm that:

I understand that:

Signature of

Collection of the personal health information on this form is for assessment and verification of eligibility for Ontario health insurance coverage, or related programs, health planning and research, and the administration of the Health Insurance Act and the Ontario Drug Benefit Act. The information may be used and disclosed in accordance with the Personal Health Information Protection Act, 2004, and as set out by the “Ministry of Health and Long-Term Care Statement of Information Practices” which may be accessed at I understand that I may withhold my consent to the collection of this information; but that in doing so may interfere with the provision of my Ontario health insurance coverage. For more information, please call ServiceOntario INFOline at 1-800-268-1154.

Ministry use only