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Pharmacy Application of Interest

Interested in learning more about PrescribeIT^TM?

PrescribeIT^TM is available in number of communities and we are working actively to scale the service across Canada. To help us plan our deployment, please complete this form:

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Contact Information:

Prefix:

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First name:(*)

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Last name:(*)

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Pharmacy name(*)

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Pharmacy Type(*)

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Unit Number:

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Street Number:(*)

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Street Name:(*)

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City/Town:(*)

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Province / Territory(*)

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Postal Code(*)

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Telephone Number:(*)

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Email Address:(*)

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Pharmacy Information:

Number of prescriptions dispensed daily:

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We dispense methadone:(*)

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Which pharmacy management system does your pharmacy use?(*)

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specify "Other" PMS:

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How are the majority of your patients’ prescriptions delivered to your pharmacy?(*)

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Is there any other information you would like to share with us?

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With PrescribeIT, prescriptions are automatically delivered to a patient’s preferred pharmacy. Learn more about… https://t.co/9XcMK883kn

by @PrescribeIT_CA