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Personal Info

First name on BC Services Card (formerly Care Card)

Last name on BC Services Card (formerly Care Card)

E-mail address

Phone number

Personal health number (located on the back of your BC Services Card)
For example: 1234 123 123

Date of birth (for example: 4 12 1995)

Day

Month

Year

Child

First name

Last name

Personal health number For example: 1234 123 123

Date of birth (for example 8 10 2020)

day

month

year

Assigned sex at birth

Female Male