Thank you for completing this form in advance of your appointment.

Nova Scotia Healthcare (MSI) may pay for some procedures and treatments, having this information on file with your record assists us to have complete information on file.

This information is also beneficial should we need to see you for an emergency appointment.

If you wish, we will try to direct bill insurance companies, where possible.

Due to the different terms that many policies have, this may not be possible for all insurance companies or policies (including those listed).