If you need assistance please call toll free 1-800-474-4474

Please print and fill out the application below. Once you have completed the application please mail it to us at the given address, or you can scan it and email it to us at inquiries@healthquotes.ca.

Application

(click on image above)

To download an application so that you can print it at a later time: Click on the "DL" image to open the PDF file, and then use the "File Save As..." menu item to save the application.

 
(click on image above to download Acrobat Reader if not installed)

Mailing Address:
Individual Health Applications,
HealthQuotes.ca Inc.,
5145 Steeles Ave. West,
Entrance A, Suite 202,
Toronto, Ontario,
M9L 1R5