07 October 2025
This form is used to apply for a reimbursement of the cost of supplies purchased from a provider that has not signed an agreement with RAMQ. Must be accompanied by the original invoices and proofs of payment.
Form 4258
Protection of your personal information In order to offer you certain services, we need to collect, use, and sometimes disclose your personal information. To find out more about our privacy practices on our website, please refer to our Privacy policy webpage.
