Forms
Whitehorse Emergency Shelter staff fill out this form for each person who stays at the facility.
If you receive social assistance, use this form to apply for housing in a government-run facility. This could be a care facility, an assisted-living facility, or a hospital.
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
You can use the abbreviated advance directive to appoint a proxy. This allows a person to make care decisions when you can no longer make your own decisions. This is valid under the Yukon Care Consent Act.
Use this form to verify accommodations when applying for rental allowance. A registered owner or approved property manager completes this form for their tenant who receives social assistance.
Use this form to apply for accommodation assistance from Income Support Services. This can be for lodging in hotels, motels, hostels, campgrounds, and RV parks. A staff person at the facility must fill out the form.
Use this form to apply to get more social assistance to cover additional expenses. You'll have to provide supporting documents for your request.
Use this form to allow your child to have a hearing screening at school.
Use this form to allow or refuse immunizations for your child in Grade 9.
Use this form to allow or refuse immunizations for your child in Grade 6.
A physician uses this form. It's to report a child's congenital anomaly, as well as to refer a mother for a genetic counselling appointment.
Use this form to ask for a review of the decision about your eligibility for, or your amount of, social assistance.
Use this form to give consent to Hearing Services to get your personal health information from another organization or agency.
The patient and health care provider must fill out this agreement when controlled medication is given. This shows an understanding and agreement with the conditions of the medication.
The patient and physician must fill out this agreement when controlled medication is given. This states that the patient will only get this medication from 1 pharmacy.
Use the child support questionnaire form to apply for child support if you're receiving social assistance. Each parent seeking support must complete this form.
Municipalities, First Nations, Government of Yukon, and other businesses or organizations use this form to apply for a permit to operate large public drinking water systems, such as wells or surface water. Environmental Health Services... more
Fill out this application and checklist to get a permit to operate a food vending vehicle.
Use this form if you are an owner, operator or agent. It lets Health and Social Services, Environmental Health Services share environmental health information with a 3rd party.
Use this form to get help to cover costs if you travel by road outside of Yukon for medical travel.
Fill out this feedback form if you've visited Environmental Health Services.
Fill out this application if you've installed a sewage disposal system without a permit before 1999 and want to keep using it.
Fill out this checklist for approval of use of your sewage disposal system. It outlines the photos and other evidence needed.
Fill out this application to get approval to use a sewage disposal system.
Fill out this form if you'd like to change your child's name. Give this form to Vital Statistics.