All 36 verified New Brunswick forms, nearly all bilingual: WorkSafeNB reports, NB Drug Plans, Social Development, student aid, Medicare prior approval and parking.
New Brunswick has 36 verified forms in this library, and 32 come in English and French. WorkSafeNB accounts for 19. Physicians and NPs use one form, Medical Form 8-10, for both the first report and progress visits, and give page 2 on functional abilities to the patient for the employer. Drug coverage runs through the NB Drug Plans Special Authorization Request (FORM-791E, or FORM-791F in French) and drug-specific forms such as filgrastim and Paxlovid.
Medical Form 8-10 is due within 72 hours of the appointment and can go through WorkSafeNB's MyServices secure email. Social Development's disability, blind and deaf certification reports aren't published online; they come from the department. Section B of the student aid Disability Verification Form won't be accepted if it is completed electronically. The library lists no New Brunswick auto insurance forms yet. Federal forms such as the T2201, CPP disability and EI certificates apply here too and are on the federal hub.
Formulaire médical 8-10
Single physician/NP report for both the First Medical Report of Accident or Occupational Disease and progress visits. Page 2 (functional abilities for return to work) is given to the patient for the employer.
Rapport audiometrique
Audiogram and audiometric findings for an occupational hearing loss claim.
Coût estimatif des services dentaires requis
Dentist or denturist's tooth charting and cost estimate for dental services needed after a work-related dental injury.
Service psychologique – Rapport d'évaluation initiale
Mental health provider's initial psychological assessment of a worker. Do not start treatment until WorkSafeNB approves it.
Examen de la thérapie par la kétamine
Pre-approval request and periodic treatment review documentation for ketamine/esketamine treatment on a WorkSafeNB claim.
Rapport d'évolution en psychologie santé mentale
Combined mental health treatment report: Initial (within 5 business days of the first session), Progress (after each 8-week block) and Discharge (within 5 business days of the final appointment).
Rapport d'évolution en physiothérapie
Physiotherapist's progress report (subjective, objective and neurological findings, ROM, treatment and goals) to the WorkSafeNB case manager.
Service psychologique – Résumé de dossier
Psychologist's discharge report: treatments, missed appointments, rehabilitation goal and discharge disposition.
Client adressé pour une admission au Centre de rééducation professionnelle
Refer a claimant to the WorkSafeNB Rehabilitation Centre for services, or request supplies, with the reason for referral.
Résumé de dossier RÉUSSIR
Mental health provider's discharge report for a worker treated in the SUCCEED program: treatment dates, work status and outcomes.
Processus d'examen de la thérapie par les opiacés – Travail sécuritaire NB
Handbook (Appendix A to Policy 25-012) that the prescriber and pharmacist complete for opioid coverage outside standard criteria and for ongoing opioid approval.
Formulaire de consultation par téléphone et de conférence de cas de Travail sécuritaire NB
Document and bill a telephone consultation or case conference that WorkSafeNB initiated or requested.
Formulaire 8-10 – Rapport du chiropraticien
Chiropractor's First Chiropractic Report of Accident or Occupational Disease and Chiropractic Progress Report to WorkSafeNB.
Formulaire 33 – Détails de l'ordonnance
Pharmacy statement of prescriptions (DIN/PIN, drug, quantity, charges) dispensed for a claim, for direct payment or claimant reimbursement.
Formulaire HA-01 – Rapport sur l'ajustement et le service relatifs à un appareil auditif
Audiologist's report of a hearing aid fitting (standing-offer or exception device), supplies and service for a claimant. Also used to confirm the visit for worker mileage.
Formulaire HA-02 – Rapport d'exception
Audiologist's request or justification for a replacement or non-standard hearing aid outside the standing-offer device list.
Physician statement for a disability pension application under the NB Teachers' Pension Plan or the Provincial Court Act / Provincial Court Judges' Pension Act.
Formulaire de vérification de l'invalidité
Verifies a permanent or persistent/prolonged disability for Canada-New Brunswick integrated student financial assistance (CSG-D and related disability funding).
Medical evidence for a social assistance applicant or client (18+) seeking certification as 'disabled' by the Medical Advisory Board, which opens the Extended Benefits Program.
Eye examination report used to certify a social assistance applicant or client as legally blind (Extended Benefits Program).
Hearing examination report used to certify a social assistance applicant or client as deaf (Extended Benefits Program).
Physician's report stating a social assistance applicant or client can't work for 6 months or more (or is 7+ months pregnant). It sets the Transitional Assistance rate and household-income exemptions, and 24 months of reports support a Long-Term Health Needs designation.
Physician statement for long-term disability benefits or continuation of benefits during disability (waiver of premium) under Province of New Brunswick employee plans.
Régimes de médicaments du Nouveau-Brunswick - Demande d'autorisation spéciale
General request for coverage of a special authorization drug under the NB Prescription Drug Program or NB Drug Plan when there is no drug-specific form.
Special authorization requests for people in provincial correctional services: general, smoking cessation therapy and Paxlovid versions.
Thérapie d'abandon du tabac - Demande d'autorisation spéciale
Special authorization for additional smoking cessation therapy coverage.
Filgrastim / Pegfilgrastim - Demande d'autorisation spéciale
Drug-specific special authorization for filgrastim or pegfilgrastim (chemotherapy support, non-malignant neutropenia, stem cell transplant support).
Nirmatrelvir/Ritonavir (Paxlovid) - Demande d'autorisation spéciale
Documents that the clinical criteria for Paxlovid coverage are met.
Confirmation de l'admissibilité médicale à la couverture des capteurs de glucose
Confirms medical eligibility for continuous glucose monitoring (CGM) sensor coverage under NBIPP.
Confirmation d'admissibilité médicale à la couverture de pompes et fournitures
Confirms a client's medical eligibility for insulin pump and/or pump supplies coverage under the New Brunswick Insulin Pump Program (NBIPP).
Demande d'approbation préalable - Assurance-maladie
Physician asks Medicare to decide before treatment whether a proposed, possibly cosmetic, service is insured: service code, units, diagnosis, deformity and functional impairment.
Demande de permis de stationnement pour personne handicapée
Application for a New Brunswick disabled parking permit and placard (temporary up to 5 years, or permanent).
MOB-FRM-060ERegistration for Fredericton Para Transit; the clinician completes a confidential questionnaire on the applicant's condition so Transit staff can assess eligibility and accommodations.
Formulaire de facturation pour l'anesthésie à l'intention des travailleurs blessés de Travail sécuritaire NB
Anaesthesiologist's billing form for anaesthesia on a WorkSafeNB claimant, including after-hours and BMI modifiers.
Compte du médecin pour consultations et actes médicaux
Physician invoice to WorkSafeNB for consultations and procedures on a claim.
Formulaire de facturation pour la chirurgie à l'intention des travailleurs blessés de Travail sécuritaire NB
Surgeon's billing form for surgery (primary surgeon, GP or specialist surgical assistant, collaborative surgery) on a WorkSafeNB claimant.
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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Both. Physicians and NPs use the single Medical Form 8-10 for the First Medical Report of Accident or Occupational Disease and for progress visits. Page 1 goes to WorkSafeNB within 72 hours of the appointment. Page 2 lists functional abilities as able or unable and goes to the patient for the employer. Send it through MyServices, fax, mail or in person; if you fax it, don't also mail it.
Not Section B. It warns that forms completed electronically, or that appear completed by someone other than the medical assessor, won't be accepted, and it needs a wet signature. Initial every page, sign and stamp it, then return it to the student, who uploads it or sends it by fax or mail. For a learning disability, a psychoeducational assessment replaces Section B.
Use a drug-specific form when one exists, such as filgrastim (FORM-968E) or smoking cessation (FORM-917E). Otherwise use the general Special Authorization Request (FORM-791E, or FORM-791F in French). Coverage needs the formulary criteria, incomplete forms are returned, and the same form handles brand-name requests after a documented reaction to a generic. The Paxlovid form (FORM-1238E) stays at the pharmacy instead.
The physician completes the Disability Category Medical Report, which Social Development provides; it isn't published online. The district office sends it with a Certification Check Sheet to the Medical Advisory Board, and certification opens the Extended Benefits Program. Blind and deaf certifications use separate examination reports. Certification is permanent, and the client's cost may be covered as a special benefit.