2024 Health and Medical Form

TteS Medical/Dental Form
PLEASE NOTE

As per the Tk’emlúps te Secwépemc Medical/Dental Assistance Policy this application must be completed in order to receive assistance. It is the individual TteS band member’s responsibility to read and understand the TteS Medical/Dental Policy.

All reimbursement cheques are mailed via TteS Finance Department-no exceptions. Please allow 10-14 days for processing.
Status Number*
PHN Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Registered Legal Name*

Given Name(s)Last Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
YesNo
File Upload*

Cancelof
Comments
* Failure to inform TteS of alternate medical/dental coverage will jeopardize future funding.
- Updated doctor notes are required annually
- Reimbursements must be accompanied with a completed application
- A drop box, with applications & envelopes, are located by the Security office for your convenience
Should be Empty:

TteS Medical/Dental Form