Forms
Use this form to submit in your expression of interest in implementing the Planet Youth Initiative. Learn more about the Planet Youth Initiative.
This is the RSV immunoprophylaxis program application form. It is to be filled out to enrol a high risk child.
Use this form to request support for people who have life-limiting illnesses. Health care professionals, family, friends or volunteers use this form. This form starts the request for a consultation with the Yukon Palliative Care Resource... more
A health care provider fills out this form. It declares that a person in care cannot make reasonable financial decisions. This will help provide financial protection for that person.
Parents or guardians complete this form to consent or refuse consent of their child’s enrolment in Yukon Children's Dental Program.
You can use this form to apply for intensive case management and outreach supports. Use this form if you are experiencing: complex mental or physical health needs; substance use challenges; housing instability or homelessness;... more
Use this form to report incidents or issues on behalf of clients or residents of continuing care facilities.
Yukon seniors who own or rent their homes can apply to the Pioneer Utility Grant (PUG) to get help with paying for home heating costs on their primary residence. Learn more about applying for the Pioneer Utility Grant. Calculate... more
Yukon seniors who own or rent their homes can apply to the Pioneer Utility Grant (PUG) to get help with paying for home heating costs on their primary residence. For renters, this certificate is completed by the landlord and submitted by... more
This form is for someone from your health-care team to fill out. It's needed to enter a continuing care facility or community day program in Yukon.
Health care providers use this form to refer your patients to the Chronic Conditions Support Program. These include: Your Health! Your Way!; Diabetes Wellness Series; supervised exercise; and Pulmonary Rehabilitation Program.
Have this form filled out to be reffered to the family Resource Unit.
This form is to apply to the Food Literacy Grant for the Kids in the Kitchen and We Can Cook programs. Submit your completed form to the health promotion team in-person, by mail, email or fax.
This is a client feedback form to be completed by clients, family members, legal advocates and people informally supporting a client.
From the Ground up early learning centre order form
Physicians use this form to report instances of rabies exposure to Environmental Health Services.
Complete this form only if you do not wish to submit a Notice of Assessment from the Canada Revenue Agency with your PUG application. Yukon seniors who own or rent their homes can apply to the Pioneer Utility Grant (PUG) to get help... more
Fill out this application to get a permit to install a sewage disposal system.
Fill out this form if you're the electrician responsible for electrical work for a property's sewage pump-up system. Give the form to the homeowner or to Environmental Health Services.
Fill out this form if you're responsible for inspecting and maintaining a septic system and soil absorption system. Give this form to Environmental Health Services once it's filled out.
Use this form to submit a bacteriological analysis of drinking water.
Use this form to apply to find a primary care provider in the Yukon.
Fill out this form if you want to be a marriage commissioner in Yukon. Give this form to the vital statistics office.