Get Bruy Re Helpline Application Form - Bruyere

Filling out the Bruy Re Helpline Application Form - Bruyere can be a straightforward process when approached step by step. This guide is designed to assist you in completing the form accurately and efficiently, ensuring that all necessary information is provided.

Follow the steps to successfully complete the application form.

1. Click the ‘Get Form’ button to acquire the document and open it in your editor of choice.
2. Begin by entering your client information. You will need to specify your preferred language, enter your Health Card Number (HCN), and provide your date of birth in the format dd/mm/yyyy. Fill in your name, address, and contact details including telephone numbers and email.
3. Indicate whether you have a security alarm system at home by selecting 'Yes' or 'No.' If 'Yes,' please provide the name of the alarm company.
4. Select how you heard about the Bruyère Helpline. You can choose from a list of options or specify another method if necessary.
5. In the installation information section, specify who should schedule the installation and provide their contact details if it is not yourself.
6. Address the billing information by indicating if a subsidy is required. If a subsidy is needed, be sure to include a copy of your notice of assessment from the Canada Revenue Agency.
7. Complete the medical information section by listing any allergies, the location of your medications, and any other relevant medical conditions or special needs.
8. Provide details about any responders, including their names, contact numbers, and relationships to you. Ensure that all responders have a key to your residence.
9. Sign the form and date it using the format dd/mm/yyyy. You can also opt to add your contact information to the Bruyère Foundation's distribution list.
10. Once all fields are completed, review the form for accurate information. You can then save changes, download, print, or share the form as needed.

Take the next step and complete your Bruy Re Helpline Application Form online today.