Health Help Alberta

Apply for family support.

Tell us what your family needs. We’ll help you take the next step.

Fill out the form here, review it, then send it through your email app. Only fields marked “required” must be completed.

Person needing support

Tell us about the person who would receive support.

First name (required)

Last name (required)

Date of birth

Canadian resident status

Please specify your resident status

Current supports

For example, an FSCD caseworker, social worker, therapies, or other support.

Language most comfortable with

English language proficiency

1 means not at all; 5 means excellent.

Other languages you are proficient in

Country of birth

Other relevant information (optional)

Parents or guardians

Add up to two parents or guardians if relevant. You can skip this step when applying for yourself.

Include parent or guardian 1

Parent or guardian 1

First name

Last name

Canadian resident status

Please specify your resident status

Language most comfortable with

English language proficiency

1 means not at all; 5 means excellent.

Other languages you are proficient in

Country of birth

Other relevant information (optional)

Include parent or guardian 2

Parent or guardian 2

First name

Last name

Canadian resident status

Please specify your resident status

Language most comfortable with

English language proficiency

1 means not at all; 5 means excellent.

Other languages you are proficient in

Country of birth

Other relevant information (optional)

How can we help?

Share what you’d like our team to understand about your situation.

Diagnosis or condition

Describe the diagnosis or circumstances that led you to contact us.

What would you like help with? (required)

For example, finding relevant programs or understanding and completing application forms.

Other relevant information (optional)

Contact & applicant details

Let us know how to reach you.

Email address (required)

Home phone

Cell phone

Home address

Applicant name (required)

Date (required)

Applicant signature (type your name) (required)

Review your application

Check your answers, then open your email app to send them to healthhelpalberta@gmail.com.

You’re in control of sending.

This site prepares your email; it does not send it or save your answers. If you close or refresh this page, your answers will be cleared.

Open email to send

If your email app does not open or leaves out answers, copy the application into an email or attach the downloaded text copy.