Medical Travel Assistance Application

Medical Travel Assistance Application

Funded by RBC
Applications must be submitted early enough for consideration and with enough time for you to receive any approved coverage in advance of your travel.

Approvals are subject to available funding.

Please note: Approved medical travel to Halifax qualifies for 1 bridge card and a $50.00 gas card per application per trip. Approved medical travel to Moncton qualifies for 1 bridge card and $25.00 gas card per application per trip.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Last 3 of Service Number*
Unit*
Where is your appointment?*
When is the appointment?*

MonthDayYear
Date
Is any portion of this trip covered by another agency? (VAC, DND, Province of PEI, etc.)*

YesNo
If you answered "Yes" above, please explain why you still need coverage from the PEI MFRC.
Who has the appointment?*

First NameLast Name
What is the relationship?*

Myself - the member or veteranMy spouse/partnerMy childOther
Requesting*

Bridge PassGas Card/sBoth
How will this assistance impact your family? *
Is there anything else we should know about this request?
Please attach your proof of appointment.

Cancelof
All applications will be considered and a response will be provided within 2 business days of receiving your request. If you do not have a family contact form on file at the PEI MFRC, please click here to complete one. Passes cannot be distributed to people not registered with the PEI MFRC. http://www.peimfrc.ca/wp-content/uploads/2022/04/PEI-MFRC-Intake-Form-2022-Fillable-.pdf
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