1 Current Page 1 2 Page 2 3 Preview Consent to organ and/or tissue donation and language profile responses are voluntary and are not required for Health Card eligibility. Personal information on this form is collected under the authority of Section 31(c) of the Freedom of Information and Protection of Privacy Act. Identification 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 Exemple : 902-555-5555 Email Address Personal Health Number (PHN) Please enter the 8-digits from your PEI health card. Date of Birth You must be 16 or older to apply.