Caring Breaths Application Form

1. Contact Information

2. Expense Receipts

Attach a copy of the receipt you are requesting financial reimbursement for.

Expense Receipts
Files must be less than 200 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

3. Support Documentation

Medical: Health Care Provider Support Letter

Attach a copy of the documentation from a health care provider stating that you or someone you are caring for requires the above request. Some examples of health care providers that can provide a letter of support includes but is not limited to; Doctors, Nurse Practitioners, Nurses, Social workers, Physiotherapists, Pulmonary Rehabilitation Exercise Therapists, Certified Respiratory Educators, Respiratory Therapists, Pharmacists etc.

Who is the letter of support for?

Please include the following information in your letter of support:

  • Identify your role in care.
  • Provide the rationale for the applicant to apply for the Caring Breath’s program.
  • Provide the rationale why the applicant would benefit from the Caring Breath’s program. 

 

Radon Mitigation: Results of Long-Term Radon Test Prior to Mitigation

Provide a copy of your long-term (minimum three months) Health Canada approved radon test results that prompted mitigation work.

Support Document
Files must be less than 200 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

4. Income Verification

What is your net disposable income? (monthly income after taxes) Choose range that applies to you.

income *

5. Other Financial Support

Select any other organizations you have received financial support from to help cover related costs.

Optional: Other Information

You may use this field to provide any other information you feel is relevant or important to your application.

Page Last Updated: 11/03/2021