Easter Seals Access2 Logo

NEW (FIRST TIME) APPLICANTS

STEP 1: FILL OUT APPLICATION

Complete “Section B – Applicant Information” (ensuring to check off the “New Card” box). The form can be found below.

Complete “Section C – Health Care Professional Authorization”. This section is to be completed by an authorized healthcare professional. Please refer to Section C for a list of accepted health care professionals.

Complete “Section D – Administration Fee Payment”.

DOWNLOAD APPLICATION FORM

STEP 2: MAKE PAYMENT

Administration Fee (2 options)

$20 for a new 3-year card

OR

$30 for a new 5-year card.

Paying via Mail

Please ensure the cheque or money order mailed to our office is:

  • Payable to “Easter Seals Canada”
  • Dated within the last 6 months
  • Signed

Paying online

Payment can be made online with a credit card or a Visa Debit card.

  • For a Visa Debit card purchase, please select the PayPal option. A PayPal account does not need to be created.
  • When purchasing an Access 2 Card online, the purchaser’s information will be automatically input under the Access 2 cardholder’s information on the next page. If the purchaser and Access 2 cardholder are different, please manually delete and input the cardholder’s name on the next page.
PAY ONLINE

STEP 3: SUBMIT YOUR APPLICATION

There are three ways you can submit your application: by e-mail, fax, or mail.

Please submit sections B, C, and D.

SUBMIT APPLICATION ONLINE