Régie de l'assurance maladie du Québec
   Request for general information

   Use this form if you wish to obtain general information on our services and programs. Please note that no information concerning your personal file or that of your family may be sent via email.

Please use a different service service for the following requests:

- Comments, suggestions or a complaint concerning the quality of service
- Reporting non-compliance with laws

* Mandatory field

First name* Last name*
Number, street*
Municipality* Province*
Country Postal code*
Phone (home)* Phone (work)
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Health Insurance Number

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