|Classification / Identification:|
| ||Form Number:||014-3233-87||Edition date: ||2021/05 |
| ||Title:||Seniors Co-Payment Program Application|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Drug Programs Delivery Branch|| || |
| ||Program:||Drug Programs Delivery Branch|| || |
| ||Purpose of Form:||For low income seniors to apply for the Seniors Co-Payment Program.
This form cannot be downloaded with most smart phones or iPads. Refer to the FAQ for more information. If you need a copy of the form, contact the Seniors Co-Payment Program at toll-free 1-888-405-0405.|| || |
| ||Ordering Information:||Submit completed order request form (form # 014-0350-93) to OSSDistribution@ontario.ca (preferred option) or fax to 416-679-8192.|
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