Name Change

Manitoba Health, Seniors and Long-Term Care

Name change

Name change
Supporting documentation

Cardholder's information

Registration number (six-digit alphanumeric)

Personal Health Identification Number (PHIN - nine digits)

Primary phone number

Email address

Can we contact you at this email address?

Legal first name

Legal middle name

Legal last name

Sex

Date of birth

Select either English or French as your official language

Current address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Is the mailing address the same as your current address?

Mailing address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Change of name (How your new legal name(s) should appear on the Manitoba Health Card)

Legal first name

Legal middle name

Legal last name

Will you require a change of address?

New residential address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Is the new mailing address the same as the new residential address?

New mailing address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Type of card

Select the type of card

Generate a new image Play the audio code

Enter the code from the image