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ADP Enteral Feeding Pump and Supplies Form (4791-67E)

Ontario's Assistive Devices Program uses this application to give grants toward an enteral feeding pump and yearly feeding supplies for people with a long-term physical disability who need enteral feeding to maintain nutrition. A physician or nurse practitioner examines the applicant and completes the device and eligibility section. ADP doesn't pay for formula, and hospital or long-term care residents aren't eligible.

Who completes it

A physician or nurse practitioner licensed in Ontario completes Section 2 (pump type, supplies, reason and eligibility statements) and signs Section 4 after assessing the applicant in person. The applicant or agent completes Section 1, signs the Section 3 consent and names the payee; there is no vendor or authorizer section.

Submitting and payment

How to submit it
Send the signed form to ADP, attaching only a vendor or manufacturer repair quote when replacing a pump, since other attachments aren't considered. ADP aims to review applications within eight weeks.

Good to know

  • Pump funding requires feeds delivered by pump for six hours or more in 24 hours; a portable pump also needs confirmation that the applicant is increasingly active and ambulatory.
  • ADP pays grants directly to the applicant or agent: one toward the pump and an annual supplies grant in four quarterly instalments, which is higher for people on social assistance.
  • Applicants can buy supplies from any vendor, must keep original receipts for at least two years, and confirm eligibility on a renewal form ADP mails every two years.
  • A pump's designated funding period is 5 years. Earlier replacement needs a change in medical condition or a pump beyond economical repair, with a vendor quote attached.

Get the official form

Download the current version from the source each time; forms change without notice.

Application for Funding Enteral Feeding Pump and Supplies

Demande de financement Pompe et matériel d'alimentation entérale

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Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who can complete the ADP enteral feeding application?

A physician or nurse practitioner licensed in Ontario, who must assess the applicant in person. They choose a stationary or portable pump and supplies, confirm the eligibility statements, and certify a chronic physical disability requiring regular use of the device. They may also refer the person to a nurse, dietitian or occupational therapist for help choosing supplies.

Does ADP pay for enteral feeding formula?

No. ADP funds feeding pumps, bags and containers, tubes, catheters and accessories, but not the formula. Its grants are a contribution toward costs rather than full coverage, so people with private insurance can check whether it covers their share. Equipment available through the WSIB, or to Group A veterans for pensioned conditions, isn't funded.

How long does ADP take to approve enteral feeding funding?

ADP aims to review an application within eight weeks of receiving it. If funding can't be approved, the applicant is notified by mail; if it is approved, the first supplies payment arrives within 30 days of the approval date. ADP then mails a renewal form every two years to confirm ongoing eligibility.