Quick Contact
Ottawa office
466 Tremblay Road
Ottawa, ON K1G 3R1

Tel: 613-231-2266
Fax: 613-231-2345
Toll Free: 1-888-613-1234
Winnipeg office
175 Hargrave Street, Suite 100
Winnipeg, MB R3C 3R8

Tel: (204) 942-4438
Fax: (204) 943-5998
Toll Free: 1-888-204-1234

Claims forms - Ottawa

Click to download the appropriate form in .pdf format.

Print, complete and sign the form. Return it, and all receipts, to Coughlin & Associates Ltd. at:

Coughlin & Associates Ltd.
P.O. Box 3517, Station C
Ottawa, ON K1Y 4H5


  • Medical claim form (original receipts required, cannot be emailed or faxed)
  • Dental claim form
  • Short term disability claim form (contact the Coughlin Ottawa office for the corresponding forms)
employee benefits specialists
Important forms
Dental - Medical Claim Forms
Dental & medical claim forms
Pre-authorized deposit forms
Pre-authorized deposit forms
Pre-authorized payment forms (Ottawa only)
Pre-authorized payment forms (Ottawa only)
If you share our dedication of providing Service Beyond Expectations™...
Personal financial programs for you and your family.
What's new
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February 24, 2016
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