Current Page 1 Page 2 Preview Personal Information on this form is collected under section 31(c) of Prince Edward Island's Freedom of Information and Protection of Privacy (FOIPP) Act as it relates directly to and is necessary for providing services under the PEI Drug Cost Assistance Act. If you have any questions about this collection of personal information, you may contact the program office at 902-368-4947 or 1-877-577-3737. Identification Please note: This webform is for renewal of coverage through the Catastrophic Drug program only. First time applicants need to fill out the Catastophic Drug Program application form. I confirm that I am currently enrolled in the Catastrophic Drug Program. I confirm that I have filed my most recent PEI income tax return with the Canada Revenue Agency. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example: C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Social Insurance Number (SIN) Personal Health Number (PHN) Please enter the 8-digits from your PEI health card. Date of Birth Do you have a spouse? - Select -YesNo