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Pharmacy Application of Interest

Interested in learning more about PrescribeITTM?

PrescribeITTM 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:(*)
This is a required field. Please fill in the appropriate information.

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:(*)
This is a required field. Please enter a valid telephone number.

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?(*)
This is a required field, please provide the appropriate information.

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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