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Northern ontario travel grant form

Northern ontario travel grant 2026

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The document outlines the application process for the Northern Health Travel Grant (NHTG) Program, which assists eligible Northern Ontario residents with travel expenses incurred while seeking medical specialist services at designated health facilities. It details eligibility criteria, required documentation, and application procedures for both patients and companions, emphasizing the importance of timely submission and completeness to avoid delays.

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Click ‘Get Form’ to open the Northern Ontario Travel Grant application in the editor.
In Section 1, enter your personal information including Last Name, First Name, Health Number, and Date of Birth. Ensure you provide accurate contact details and confirm if any travel costs are covered by another program.
Section 2 requires your referring provider to complete their information. They must certify the referral to the nearest specialist and sign the section.
In Section 3, the specialist or health facility must fill in details about the service provided, including their signature and date of service.
If applicable, Section 4 is for advance funding by a third-party agency. Provide their details and ensure you sign this section.
Finally, if applying for a companion grant, complete Section 5 with your companion's information and signature.

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