Health care professionals use this 9-page application to ask Health Canada's Medical Devices Special Access Program for a device not licensed in Canada, a Class III or IV custom-made device, or an emergency batch. It applies when emergency use is needed or conventional therapies have failed, are unavailable or are unsuitable. Health Canada only authorizes the import and sale; purchase and import costs aren't covered.
The treating health care professional completes every section, from application type and device identifiers to the medical rationale, and signs the Section H attestation. Each professional submits their own application, with only one professional and one manufacturer per form.
Download the current version from the source each time; forms change without notice.
Application Form for Special Access Medical Devices
Formulaire de demande d'accès spécial aux instruments médicaux
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.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Not Health Canada. Its role is limited to authorizing the import and sale of the device to the health care professional, and purchase and importation costs aren't covered. Health Canada directs patients to their provincial or territorial health authority or private insurer. Authorization also doesn't oblige the manufacturer to sell the device.
Requests can be refused when the device or a similar one is already licensed in Canada, the use is investigational, the device is wanted because it costs less, the need isn't unique, risks outweigh benefits, conventional therapy would work, or a batch isn't justified. Incomplete or unreadable applications are rejected automatically.
Yes, as a batch request when future emergencies are expected and shipping delays would affect patients. Tick the anticipatory supply option in Section A and complete Section G with the emergency condition and the number of devices needed for one month. For a procedure within 3 days, mark it as an emergency.