Nursing care health assessment form
Bought Freedom to Choose™ health and dental insurance coverage directly through Canada Life? You’re in the right place.
If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.
Submit your claim online
Your online account makes it easy to submit your claims online or print forms that are pre-filled with your personal information.
If you have Freedom to Choose™ health and dental insurance coverage you bought online through Canada Life, use this form to apply for a pre-care assessment and see the amount of nursing care coverage you could receive.
Step 1: Complete a form.
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save. Complete the plan member section.
Use this form to apply for a pre-care assessment for nursing care. You’ll need the doctor and case coordinator/manager to fill in some sections.
Step 2: Submit your request for approval.
You’ll find instructions on how to submit your claim on the form itself.