Application for Health Care for Mental Health Condition(s)

Form ID
D9213
Audience
General

Most people submit their claims online. People find it quicker and easier to submit claims this way.

You can submit this claim through MyService.

Use this form to apply for health care if you require treatment for a mental health condition.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
myservice
Form (PDF or Word)