• INSURANCE COVERAGE & PAYMENT FORM

  • Please fill in all of the information below to the best of your ability.

    These are the Insurance Providers of Extended Health Care from which Empower Health Clinic can likely accept Direct Billing: 

    • CINUP
    • Chambers of Commerce Group Insurance Plan
    • Cowan
    • Desjardins
    • First Canadian
    • Great-West Life
    • Industrial Alliance
    • Johnston Group
    • Manulife
    • Maximum Benefit
    • Standart Life
    • Sunlife
    • Greenshield
    • SSQ Financial Group
    • Pacific Blue Cross
    • The Co-operators
    • Nexgen RX
    • Equitable Life
  •  
  •  

  • Thank you very much! Once submitted, this information will go straight to our front desk team. If you would like a copy of the completed form, please contact us!

  •  - -
  • Reload
  • Should be Empty: