1) Need to renew your forms with Broken Coast?
FORM A (Online) - Applicants with a permanent address
FORM A (PDF) - Applicants with a permanent address
FORM B - Applicants who do not have a permanent address (Applicant currently resides in a shelter, hostel, or similar institution.)
FORM C - Applicants with a permanent residential address and (a) responsible individual(s) and/or (b) who are having their product shipped to their health care practitioner.
2) Need to amend information on your registration document?
- Changes to your residential, mailing, or shipping address
- Changes to your name or gender
- Changes to your Responsible Individual(s)
- Changes to a non-residential address (a shelter, hostel, or similar institution)
- If you have your product shipped to your health care practitioner, and your practitioner has had a change of address
Questions? Comments? Contact us using the form below:
You can also contact us by telephone at 1-888-486-7579, or by email at firstname.lastname@example.org.
Our office hours are from 8 a.m. to 4 p.m. PST, Monday to Friday.
Mailing Address: Box 1150
Ladysmith, BC, V9G1A8