Medavie blue cross provider registration: Fill out & sign online

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How to use or fill out INTERIM FEDERAL HEALTH PROGRAM (IFHP) with our platform

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Click ‘Get Form’ to open the INTERIM FEDERAL HEALTH PROGRAM (IFHP) Provider Registration Form in the editor.
Begin with Part A: Provider Information. Fill in your Provider Name, Business Name, and complete the Business Address fields including City, Province/Territory, Postal Code, Telephone Number, and Fax Number. Ensure your E-mail Address is accurate for communication.
Select your Language of Choice by checking either English or French. If there is a different Contact Person, provide their details as well.
In Part B: Provider Type/Specialty, specify your Provider Type (e.g., Physician) and include any applicable Designated Panel Physician Number or Medavie Blue Cross Provider Number.
Complete Part C: Comments/Additional Information if necessary. This section allows you to provide any extra context or information relevant to your application.
Finally, review the Attestation Statement carefully. Print your name, sign it, and date it before submitting the form via fax or email as instructed.

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