Interruption of service

This form will be unavailable on June 11 starting at 4:00 am. Normal operations are expected to resume on June 11 at 9:00 a.m. Thank you for your understanding.

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Apply for the reimbursement of external breastforms

You may apply online for the reimbursement of external breastforms purchased in Québec.

Unless otherwise indicated, you must answer all questions.

Your identity

First name

Last name

Date of birth

Example: Thirty-one, then slash, then zero one, then slash, then nineteen fifty-five

Health Insurance Number

Example: Four letters “A”, followed by four nines, followed by four nines

ext.apt.Attached documents