Government of Yukon

Government Services

Health and Social Services

A to Z forms

Adoption

Accessing Adoption Records from Yukon Government and Family and Children's Services
English French (yg5654)

Cancel a Disclosure Veto or No-Contact Declaration
French English (yg5652)

Disclosure Veto and Statement
French English (yg5655)

Identification Particulars of Adopted Person
French English (yg5696)

No-Contact Declaration and Statement
French English (yg5653)

Statutory Declaration and Undertaking
French English (yg5651)

Adult Protection and Decision-Making Act

Supported Decision-Making Agreement Form
English French (yg5255)

Representation Agreement Form
French English (yg5256)

Birth Certificates

Birth Certificate Application
Bilingual (YG3385)

Care Consent Act Forms

Abbreviated Advance Directive
Bilingual (yg5394)

Emergency Medical Information Form
Bilingual (yg5571)

Form 1 (CCA) - Certificate of Legal Consultation
English French (yg5260)

Form 2 (CCA) - Certificate of Need for Financial Protection
English French (yg5257)

Form 3 (CCA) - Cancellation of Certificate of Need for Financial Protection
English French (yg5258)

Form 4 (CCA) - Statement by a Close Friend before they are Chosen as a Substitute Decision-Maker
English (yg5283)

Form 5 (CCA) - Last Resort Substitute Consent by Care Providers
English (yg5282)

Form 6 (CCA) - Application to the Capability and Consent Board for matters under the Care Consent Act
English (yg5284)

Resuscitation and Care form
English (yg5262)

Child Care

Family Day Home Menu Declaration
French English (YG5703)

Attendance Record – Direct Operating Grant
French English (YG5702)

Child Care Subsidy Form
English French (YG4586)

Child Care User Subsidy - Eligibility
Bilingual (YG2279)

Child and Family Services Act

Statutory Declaration and Undertaking
English (yg5651)

Cancel a Disclosure Veto or No-Contact Declaration
English (yg5652)

No-Contact Declaration and Statement
English (yg5653)

Accessing Adoption Records from Yukon Government, Family and Children's Services
English (yg5654)

Disclosure Veto and Statement
English (yg5655)

Identification Particulars of Adopted Person
English (yg5696)

Death Certificates

Death Certificate Application
Bilingual (YG3385)

Insured Health

Temporary Absence
Bilingual (yg3383)

Marriage Certificates

Marriage Certificate Application
Bilingual (YG3385)

Medical Travel

Out-of-Territory Medical Travel Subsidy Form
English French (YG4840)

Out-of-Territory Medical Travel via Road to Scheduled Appointments
English French (YG4857)

Mental Health Act

Form 21 - Consent of Disclosure, Transmittal or Examination of a Patient Record
English (yg4008)

Form 20 - Statement of Disagreement with a Clinical Record
English (yg4007)

Form 19 - Request for Correction of the Clinical Record
English (yg4006)

Form 18 - Application to Withhold Clinical Record
English (yg4005)

Form 17 - Certificate of Return
English (yg4004)

Form 16 - Temporary Release of Involuntary Patient
English (yg4003)

Form 15 - Application for Transfer of a Non-Resident Involuntary Patient
English (yg4002)

Form 14 - Renewal of Proposed Patient Transfer
English (yg4000)

Form 13 - Notice of Intention to Transfer an Involuntary Patient (Yukon Resident)
English (yg3990)

Form 12 - Certificate of Change of Status
English (yg3998)

Form 11 - Certificate of Renewal of Involuntary Admission
English (yg3997)

Form 10 - Authorization for Specified Treatment
English (yg3996)

Form 9 - Application to the Capability and Consent Board for Matters under the Mental Health Act
English (yg3988)

Form 8 - Waiver of Right to an Automatic Hearing
English (yg5281)

Form 7 - Certificate of Involuntary Admission
French English (yg3989)

Form 6 - Patient's Right to be Informed
English (yg4077)

Form 5 - Recommendation for Involuntary Psychiatric Assessment (Nurse)
French English (yg3987)

Form 4 - Reccomendation for Involuntary Psychiatric Assessment (Physician)
French English (yg3986)

Form 3 - Statement of Peace Officer on Apprehension
English (yg3985)

Form 2 - Order to Apprehend
English (yg3984)

Form 1 - Application for Order for Involuntary Examination
English (yg3983)

Public Health and Safety Act

Bacteriological Analysis of Drinking Water (batch submission form)
Bilingual (YG5776)

Sampling Site Infomation Form (batch submission form)
Bilingual (YG5777)

Photographic Record of the Stages of Installation of a Sewage Disposal System
French English ()

Septic Tank and Sewage Holding Tank Installation Declaration
French English (YG5742)

Notification of Abandonment and Reclamation of a Sewage Disposal System
English French (yg5589)

Application for a Permit to Operate a Large Public Drinking Water System
English (YG5453)

Application for a Permit to Operate a Trucked Drinking Water Distribution System
English (YG5452)

Notification of Installation and Undertaking to Maintain a Sewage Holding Tank
French English (YG4673)

Notification of Installation and Undertaking to Maintain a Septic Tank and Soil Absorption System
English French (YG4674)

Application for Permission to Retain a Sewage Disposal System
Bilingual (YG5073)

Application for a Permit to Install a Sewage Disposal System
English French (YG4307)

Application For Authorization to Construct, Install and/or Use a Privy
Bilingual (YG5438)

Rabies Protocol

Rabies Risk Investigation Form ‘A’
English (YG5812)

Rabies Risk Investigation Form ‘B’
English (YG5813)

Travel for Medical Treatment