Northern Ontario - How to Complete the NHTG Form

All applications are required to be in their original form, no photocopies, emailed or faxed versions. The application must have inked signatures to be approved by the Ministry of Health Ontario.

Link to form – NHTG Application

Step 1: Section 1: Patient Information - This section is mandatory to fill in by the patient. Patients must fill in key details such as OHIP number, first and last name, address, date of birth, contact details, and must indicate the type of transportation used for travel. Those eligible must indicate here whether you have travelled with a companion and the type of transportation taken into Toronto.

Step 2: Section 2: Companion Information - This only applies to patients travelling with a companion, such as a parent/guardian or other. It is only necessary to fill this out if it is applicable to the patient. If not, it can be left blank. The Northern Health Travel Grant also reimburses for ' travel expenses.

Step 3: Section 3: Advance Funding by Third Party Agency/Society -This section must be completed. Our address is: 110 Eglinton Ave E, Suite 501, Toronto, Ontario, M4P 2Y1. Code number is 0207. Tick the box directing funds from the grant be deposited to Hope Air.

Step 4: Section 4 – Payment Preference - In most cases, patients are not required to complete this section. Hope Air receives cheques from the ministry of health upon assessment of applications.

Step 5: Section 5 – Patient/Guardian/Substitute Decision Maker Authorization - This section must be completed. Either the patient, parent, or SDM, signs this section of the application.

Step 6: Section 6 – Specialty-Service Provider Information - This section must be completed by the specialist provider. It should list the date of service (appointment) and the providers details. The specialist's signature should be printed at the bottom of the application. Patients need to bring this application with them to their appointments to ensure that the specialist will sign. If this step has been missed, patients are asked to send the form to their specialist via the mail (post) and then have the doctor's office forward this on to Hope Air’s mailing address.