Régie de l'assurance maladie du Québec
    Contact Us by secure e-mail
   
   Please note that we do not reply by email to requests requiring the communication of personal information.

* * Compulsory field

Title
First name* Last name*
Number, street*
Municipality* Province*
Country Postal code*
Phone (home)* Phone (work)
Birthdate*
Open the calendar
Health Insurance Number
E-mail*
Message*


  Retype the characters from the picture:
Retype the CAPTCHA code from the image
Change the captcha codeSpeak the captcha code