1 Information on the invoice
2 Fin

Request a reimbursement for covered services obtained outside Québec

Information on the invoice

First and last names of the professional who provided the services

Name of the clinic, pharmacy or hospital

Payment of the invoice

Invoice paid in full

Invoice paid in part

Unpaid invoice

Date of payment

Example: Thirty-one, then slash, then zero one, then slash, then twenty twenty

Total amount of the invoice

Amount $

Currency

Description of the services

Examples: examination, surgery, consultation, purchase of medications, etc.

Attach a file

All documents are required. Any missing document will delay the processing of your application. You must provide documents in English or French.

The total size of the files must not exceed 15 MB.
Accepted formats: PDF and image (JPG).

Invoice and proof of payment

For each service received, you must attach the invoice and proof of payment showing that you paid the invoice (examples: receipt, cash sales slip, mention “Paid” stamped on the invoice).

Select a file

Other documents (optional)

Attach any other documents that may be useful in analyzing your application.

If the application concerns major surgery, attach the operation report.
If you have power of attorney to act on behalf of another person, you can attach it to your application.

Select a file