PEI Health Card Application for New Residents

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Personal information on this form is collected under Section 8 (Registration of Entitled Persons) of Prince Edward Island’s Health Services Payment Act (Regulations) and will be used to ensure a resident’s entitlement in respect to basic health services. If you require additional information, please contact Medicare Services, 126 Douses Road, Montague, PE C0A 1R0, 1-800-321-5492.

Identification
For example C1B 0X1 or 12345
For example 902-555-5555
Country and Province (if applicable)

Note: You are required to submit a verification letter for your proof of current enrollment from your school, along with a copy of your Study Permit, before your application will be processed.

Previous Residence
Provide the full mailing address if your previous residence is within Canada, otherwise, only your previous country of residence is required.

Note: You are required to submit a verification letter for your proof of current enrollment from your school, along with a copy of your Study Permit, before your application will be processed.

For example: yyyy-mm-dd
Organ and Tissue Donor Decision

The information below will be stored in a secure computerized PEI Donor Registry. In the future, your organ and/or tissue donor decision will be displayed on your new Health Card. For more information about organ and tissue donation, please call: 902-368-5920

This includes lungs, heart, liver, kidneys, pancreas, small bowel.
This includes skin, eyes, bone and related structures, heart valves/pericardium.
Language Profile

In order to plan for service delivery, please answer the following questions related to your language profile. Your preferred language of service will be displayed on your new Health Card.

The language you first learned in childhood and still understand.