1 Send documents related to an application for review underway
2 Topic of the request
3 Attach documents
4 Next
5 Fin

Send documents related to an application for review underway

Unless otherwise indicated, please fill all the fields.

Your contact information

First and last names

Email address

Health Insurance Number

I don’t have a Health Insurance Number.

Example: 4 lettres A, 4 chiffres 9, 4 chiffres 9

File number (optional)

The file number can be found on the decision letter you received.

Example: 4 lettres A, 4 chiffres 9, 4 chiffres 9

Don’t have a Health Insurance NumberLive outside QuébecApplication for review explanationRelation with the sender : Identity of the senderContact information of the senderapp. ext.Topic related to your applicationAuthorization to disclose decisionPrior authorization for Plastic surgery servicesRenseignements sur la demande