Re-Apply for the Ostomy Supplies Program

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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 or at the address on this form.


Please note: This webform is for renewal of coverage through the Ostomy Supplies Program only. First time applicants need to fill out the Ostomy Supplies Program Patient Application.

For example: C1B 0X1 or 12345
For example 902-555-5555
Please enter the 8-digits from your PEI health card.
A spouse is a person who is your partner in a marriage or common-law union.