1 identity 2 Your contact information 3 Votre situation 4 Next 5 Fin webform_started Apply for financial assistance for the purchase or replacement of ostomy appliances You can register online for the financial assistance program for the purchase or replacement of appliances for persons with a permanent or temporary ostomy. Unless otherwise indicated, you must answer all questions. Your identity Your identity First name Last name Date of birth Example: 31/01/2005Thirty-one, then slash, then zero one, then slash, then two thousand five Health Insurance Number Example: AAAA 9999 9999Four letters A, followed by four nines, followed by four nines ext. Leave this field blank
