Location: Forms Home > Quick Search > Quick Search Results > Form Details

Form Details

Form Format
FormatForm Link AddressFunctionalitySize
Adobe PDF   Application for OHIP Direct Bank Payment for Health Care ProfessionalsThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print119.0 kb

Form Classification
Classification / Identification:
 Form Number:014-7698-84Edition date: 2013/11 
 Title:Application for OHIP Direct Bank Payment for Health Care Professionals
 Ministry:Health and Long-Term Care  
 Branch/ABC:Claim Services Branch  
 Program:Claims Services  
 Purpose of Form:form used so physicians can have direct deposit of payment of claims  

You must download Adobe Acrobat Reader (version 10.0 or above) to view/print PDF forms.
Click here for further instructions.

If PDF forms do not open in the latest versions of Firefox and Chrome, click here for the solution.

Protecting Your Information: If you are using this online service on a shared computer in a public area (i.e. public library), it is important to ensure that you do not leave the computer unattended while accessing the service. Before leaving the computer, it is also important that you fully exit the application, clear your browser's cache (This link opens in a new window) and close down your browser. This will ensure that no one else can access any personal information you may have entered.