Registration and Renewal Forms

PDF
Medical Document

To be filled out by your health care practitioner.

PDF
Medical Client Registration

For applicants with a permanent address.

PDF
Expanded Medical Client Registration

For applicants who do not have a permanent address (applicant currently resides in a shelter, hostel, or similar institution.)
For 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.

Amendment Forms

PDF
Address

Changes to your residential, mailing, or shipping address.

PDF
Name/Gender

Changes to your name or gender.

PDF
Responsible Individual(s)

Changes to your Responsible Individual(s).

PDF
Non-Residential Address

Changes to a non-residential address (a shelter, hostel, or similar institution).

PDF
Physician Address

If you have your product shipped to your health care practitioner, and your practitioner has had a change of address

Paper forms can be sent to Broken Coast at: Box 1150, Ladysmith, BC, V9G 1A8
*Please mail via Canada Post. Couriers such as FedEx and UPS cannot deliver to PO boxes.

Thank you for visiting Broken Coast!
Before entering our site, whether you are just stopping by or are a longtime client, we kindly ask that you verify your date of birth and province.