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1 to 5 of 5 forms for the search : medical
Title and description Release Date

Medical report (SR-2100A) (PDF, 273 KB)

This is not an official form. It is a guide to help physicians complete the “Rapport medical” (SR-2100) form, which is available in French only. The physician must complete the official French form in order for us to determine whether you have temporary or permanent functional limitations.

July 2019

Certificat médical (French only) (SR-0040) (PDF, 266 KB)

Form to be completed by a physician. Required to confirm a pregnancy or health condition that entitles the employment-assistance recipient to a special benefit. Submit the completed form in person or by mail to your local employment center.

October 2018

Application for Payment of Medical Transportation (SR-2589A) (PDF, 129 KB)

General form to be used when requesting reimbursement of medical transportation.

April 2017

Application for Payment of Medical Transportation—Therapeutic Activities (SR-2590A) (PDF, 132 KB)

Form to be used when requesting reimbursement of the cost of public transit in order to participate in therapeutic activities. 

February 2016

Application for payment of moving expenses (SR-0113A) (PDF, 52 KB)

Form required at the request of the local employment centre. Necessary to apply for the special benefit for a move due to an unhealthy living environment (municipal report required) or health reasons (medical report required).

Submit the completed form in person or by mail to your local employment centre.

Dynamic PDF

By default, Acrobat prints documents in letter format. To print this form on legal size paper (8 1/2 X 14), adjust printing configuration.

October 2015