Update Email Address

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Manitoba Health, Seniors and Long-Term Care

Update email address

Update email address
Form completed by

Cardholder's information

Registration number (six-digit alphanumeric)

*

Personal Health Identification Number (PHIN - nine digits)

*

Primary phone number

*

Legal first name as shown on your Manitoba Health card

*

Do you have a middle name?

Legal middle name as shown on your Manitoba Health card

*

Legal last name as shown on your Manitoba Health card

*

Select either English or French as your official language

Date of birth

*

Update email address

Previous email address

**

New email address

**

Can we contact you at the new email address?

Current address

Street address (or PO box number)

*

City

*

Province

Postal code

*

Is your mailing address the same as your current address?

Mailing address

Street address (or PO box number)

*

City

*

Province

Postal code

*

Type of card

Select the type of card

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