Completion of form

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    To request an online completion of a form by your doctor, you must complete the information below and attach the form to be completed. Completion of a form is not a service covered by Medicare. Therefore, fees apply, based on the Federation of Physicians' fee scale. These fees vary according to the type of form to be completed. If you have more than one form to complete, you must make a separate request for each of them.

    Before sending us your request, please make sure that :

    • You have completed the Patient’s Authorization and/or Patient’s Identification section of your from
    • You have signed the form in the required place
    • You have indicated on the form the starting date of your disability/absence/accident (SAAQ) or other

    Please note that following the review of your medical record, your doctor may ask to see you in order to complete your form. In this case, we will contact you to schedule an appointment.

    Once you have filled out the request below and you have uploaded your form to be completed by your doctor, we will be happy to process your request within 15 business days if your doctor is not absent (on vacation, congress or other).

    Please remember to check your ''spam'' or ''junk'' folder if you do not receive a response from us within 15 business days.  

  • AAAA slash MM slash JJ
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  • Choose your form...Disability Insurance (with the insurance company form) 95 $SAAQ : Permits renewal 95 $SAAQ : Request for parking tag for disabled persons 60 $SAAQ : Initial Report 40 $SAAQ : Medical Evaluation Report 125 $SAAQ : Medical Evolution Report 125 $SAAQ : Medical Report of the sequelae 125 $PROVINCIAL tax credits for disabled persons 80 $FEDERAL tax credits for disabled persons 80 $Request for adapted transport (Société de transport de Montréal) 60 $Certificate of Good Health (camp, schools, travel abroad, etc.) 60 $Certificate of absence from work (with Physimed's form) 25 $Other 85 $
  • Types de fichiers acceptés : pdf, jpg, png, doc, docx, Taille max. des fichiers : 32 MB.
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    Please send us your form by mail to the following address:

    Attention: Physimed - Patient Services
    6363 Trans-Canada, Ville Saint-Laurent, suite 212
    Qc. H4T 1Z9

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    Please fax us your form to the following fax number: 514 747-8184

  • Prix: $ 0.00 CAD
  • Prix: $ 0.00 CAD
  • $ 0.00 CAD
  • (You will receive a copy of your documents via a highly secure email. You will need to enter the password you chose in order to access your file.)
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  • After clicking on the ''submit'' button, please do not exit this page before being redirected to the confirmation page.

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