Pharmacy Forms

EAP Form

The EAP form helps patients access exceptional drug coverage through government program.

Download EAP Form

Seniors Co-Pay Form

The seniors co-pay under ODB is a small fee seniors pay for prescriptions covered by the Ontario Drug Benefit.

Download Co-Pay Form

Trillium Program Application

Income‑based drug coverage for Ontarians 25‑64 with high drug costs & no full ODB/pvt plan.

Trillium Application Form

Blood Pressure Chart

A blood pressure chart tracks readings to help manage hypertension and support heart health.

Blood Pressure Chart

Nutrition Products Form

Nutrition-form fees covered by ODB for eligible patients (Ontario Drug Benefit).

Nutrition Products Form

Blood Sugar Chart

A blood sugar chart tracks glucose levels to help manage diabetes and maintain healthy blood sugar control.

Blood Sugar Chart

Funding for Insulin Syringes for Seniors

Funding support to provide insulin syringes for low-income seniors managing diabetes.

Insulin Syringe Funding Form