Breast Prosthesis Grant Information Sheet 2025

1. Click ‘Get Form’ to open the Breast Prosthesis Grant Information Sheet in the editor.
2. Begin by filling out your biographical information. Ensure you provide your last name, first name, address, health number, and date of birth accurately.
3. In the 'Confirmation of Eligibility' section, check the appropriate boxes based on your situation. Indicate if you are receiving social assistance benefits or if you have undergone a mastectomy or lumpectomy.
4. Specify the type of prosthesis purchased and indicate whether it is for the right or left side. If applicable, check the reason for replacement.
5. Review all entered information for accuracy. Once confirmed, sign and date the application at the bottom of the form.
6. Attach your original receipt from the vendor and ensure all documents are ready before mailing them to the specified address.

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