Forms

Displaying 1 - 25 of 143
July 29, 2022

This is the order form for the From the Ground Up fundraiser for schools.

July 14, 2022

This form is to consent to the disclosure of health information to another person. It should be filled out and submitted to a privacy officer. For more information, learn about how we protect your health information. Or, ... more

July 14, 2022

This form is to be completed by a physician or nurse. It determines a person's capacity under the Health Information Privacy and Management Act (HIPMA). 

July 14, 2022

This form is completed to declare authority in the matters of a deceased person. A person can become a representative to exercise the rights and powers of the deceased.

July 14, 2022

This form lets people declare their status as a substitute decision maker. They can then submit an access to information request on behalf of another person.

July 14, 2022

This form is for people to declare their status as a parent or guardian. They can then submit an access to information request.

July 14, 2022

This form is for a minor to consent to the release of the personal health information. It allows their parent or guardian to apply for an access to information request.

July 13, 2022

Verification of income by employer form when applying for the child care subsidy. The child care subsidy assists families who may not be able to afford to pay for their child to attend a licensed child care centre, family day home or... more

June 30, 2022

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

June 30, 2022

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

June 23, 2022

Use this form to request your personal health information or records from Health and Social Services.

June 23, 2022

Use this form to ask how your personal health information or records were used by Health and Social Services.

June 23, 2022

If you're pregnant and looking for a midwife, use this form to apply to the Yukon midwifery program.

March 3, 2022

Complete the Food Literacy Grant final report once your project is complete. Submit your completed report to the health promotion team.

March 3, 2022

Fill out the person release form for the Food Literacy Grant when submitting images, video or sound recording with your final report for the Food Literacy Grant. 

February 16, 2022

Download and complete this form to apply to be certified as an early childhood educator.

January 20, 2022

This form is to consent to the release of health information to another individual for proof of vaccination credentials. It should be filled out and submitted to a privacy officer.

December 15, 2021

Use this form to report incidents or issues on behalf of clients or residents of continuing care facilities.

November 5, 2021

This form is to help you apply to become a volunteer for continuing care's volunteer services program. Fill it out and return it to the volunteer coordinator. If you are under the age of 18, parent or guardian consent will be required.

October 29, 2021

This form is to be filled out by a parent or guardian. It grants consent for a minor to apply to volunteer for continuing care.

October 29, 2021

This survey is to gather feedback from volunteers for the continuing care team. It helps to improve the program for future volunteers and residents.

October 29, 2021

This survey is to help provide improve the volunteer program for continuing care. Return the completed survey by email, mail or in-person.

October 25, 2021

This is the RSV immunoprophylaxis program application form. It is to be filled out to enrol a high risk child.

October 15, 2021

This form is used to get a health approval and inspection for a new facility, location or ownership of a business. This includes beverage production and manufacturing, a care facility, a personal service, and bed and breakfast.

September 24, 2021

This form is to access volunteer shopper services for a resident of a continuing care facility. Fill out this form and return it to the care coordinator.