HSA Intake Form – Business Owner

🧾 PC Metro HSA Intake Form – Business Owner

Thank you for your interest in setting up a Health Spending Account (HSA) with PC Metro Health & Dental Benefits Ltd.

Please complete the following short form so we can follow up with the right next steps based on your interest.

I would like more information about how an HSA works.I’m ready to proceed with setting up a Health Spending Account.

Full Name

Phone Number

Email Address

Business Name

Business Address

City & Province

Postal Code

Website (optional)

Are you incorporated?

YesNo

Type of Business or Industry:

Approximate Number of Employees (including owner):

Once we receive your completed intake form:

- If you selected “more information,” we’ll send you a digital info kit.

- If you’re ready to proceed, we’ll send your full HSA Application Form and next steps.

Questions? Contact us at info@pcmetro.ca or 604-767-6426.