Application for Health Care for Mental Health Condition(s)

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

You can submit this claim through MyService.

Form ID: 
D9213
Audience: 
General

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