Northwest Territories Department of Health and Social Services Forms
The Northwest Territories Department of Health and Social Services is responsible for providing healthcare and social services to the residents of the Northwest Territories in Canada. They ensure access to quality healthcare, promote and protect public health, and support individuals and families in need of social services.
Documents:
52
This form is used for submitting an application to the Review Board in the Northwest Territories, Canada. It is used for requesting a review of a decision made by a government agency or department.
PDF 
Word
This form is used for residents of the Northwest Territories, Canada to apply for a waiver of fees for a name change and related certificates.
This form is used for applicants who want to change their name and require a duplicate certificate in the Northwest Territories, Canada. The form is available in both English and French.
This form is used for submitting out-of-territory/country claims in Northwest Territories, Canada. It is available in both English and French.
This document provides information on how to respond to an overdose and administer naloxone, a medication that can reverse opioid overdoses. It is specific to the Northwest Territories in Canada.
This Form is used for changing the sex designation on official identification documents for individuals who are 19 years of age or older in the Northwest Territories, Canada. This form is available in both English and French.
This Form is used for changing the sex designation for independent minors aged 16-18 in the Northwest Territories, Canada. It is available in English and French.
This form is used for individuals under 19 years of age in the Northwest Territories, Canada, who wish to change their sex designation. The form is available in both English and French.
This form is used for submitting a statutory declaration to provide details about the breakdown of a spousal relationship in the Northwest Territories, Canada. It is available in both English and French.
This form is used for making a statutory declaration to change your name to your common-law spouse's name in the Northwest Territories, Canada. It is available in both English and French.
This form is used for individuals 19 years of age or older in the Northwest Territories, Canada, who want to change their sex designation for a second or subsequent time. The form is available in English and French.
This form is used for declaring one's residency in the Northwest Territories of Canada. It is available in both English and French languages.
This Form is used for applying for a Personal Service Establishment Permit in the Northwest Territories, Canada.
This form is used for the NWT Health Care Plan in Northwest Territories, Canada. It is the Temporary Absence form, which allows residents to request coverage during a temporary absence from the territory. The form is available in both English and French.
This document is an application form for the Extended Health Benefits - Specified Disease Conditions Program in the Northwest Territories, Canada. It is available in both English and French. Use this form to apply for health benefits related to specified disease conditions.
This form is used for notifying changes in the Northwest Territories Health Care Plan in Canada. It is available in both English and French.
This form is used for submitting an appeal request to the NWT Medical Travel Program in Northwest Territories, Canada. It is available in both English and French.
This Form is used for applying to organize a food establishment event in the Northwest Territories in Canada. It is available in both English and French.
This form is used for applying for a food establishment permit in the Northwest Territories of Canada. It is available in both English and French.
This Form is used for applying for the Seniors Program Application for Extended Health Benefits in the Northwest Territories, Canada.
This form is used for claiming medical travel expenses in the Northwest Territories, Canada.
This Form is used for nominating members for the Regional Wellness Council (RWC) in the Northwest Territories, Canada. It is available in both English and French.
This form is used for recording bacteriological water sampling in the Northwest Territories, Canada. It is specifically for detecting the presence or absence of coliform bacteria in water samples.
This form is used for recording the weekly log of a water treatment plant in the Northwest Territories, Canada. It helps track important information and ensure proper operations of the plant.
This document is a Healthy Eating Assessment specific to the Northwest Territories in Canada. It is used to evaluate and assess an individual's eating habits and determine their overall level of healthy eating.
This document provides information about physical activity in the Northwest Territories of Canada. It includes guidance, resources, and programs to promote a healthy and active lifestyle in this region.
This document provides guidelines for the Funeral, Burial and Cremation Program in the Northwest Territories of Canada. It outlines the procedures and requirements for funeral, burial, and cremation services in the region.
