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: 3695 Drinkwater Rd. Duncan, BC V9L 0E9

Thank you for visiting Broken Coast!
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