PHSP/HSA Plan Forms

These PDF forms can be downloaded and printed, or filled in and emailed (see the top left-hand corner of each PDF).
Try our secure email service to send us any document.  Follow this link
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1. Registration Form

We need this for all plans.  We can help you fill in the blanks if you call us at 403-632-5226.

2. Appendix A – Eligible Employee(s)

Appendix A is required for all incorporated businesses AND proprietorships with arms-length employees.

3. Appendix B – Plan Configuration & Funding Options

We need Appendix B for all plans. Please call for assistance if you need it.

4. Appendix C – Family Members

Appendix C is required for unincorporated businesses.

5. Pay-As-You-Go Plan Claim Form

This claim form must be accompanied by a cheque from your employer in order to process your claim.

6. Pre-Authorized Plan Claim Form

You can send this claim and receipts directly to us, bypassing your employer if they have a PAD plan.

7. Direct Deposit Request Form

By sending us a VOID cheque you agree to the terms of this request form whether you send this form or not.

8. Pre-Authorized Debit Agreement

This form only needs to be signed and submitted once, and can be cancelled anytime.

To make credit card payments online to DR Associates, go to "2. Fund Your Plan".  A 3% surcharge will apply to all credit card payments EXCEPT the one-time $100.00 registration fee.  No GST is payable on the registration fee.