Skip to main content
Important notice

COVID-19: Information in effect as of January 8, 2021

Our services are available online and by telephone. In compliance with the new sanitary measures and to limit physical contact, our offices are no longer accessible. If you have any questions, please refer to the webpage Questions and answers about our services during the pandemic.

Application for Reimbursement – External Breastforms Program

Form
Updated on

 23 February 2021

This form is used to apply for a reimbursement of the cost of breastforms purchased in Québec. Must be accompanied by the original invoices and proofs of payment, as well as a medical prescription in the case of a first application.

Form 3198

Related topics