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Pharmacy Application of Interest

Interested in learning more about PrescribeITTM?

At the present time, the service is only available in select communities as we prepare the PrescribeITTM technology for larger scale rollout starting in 2018. 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(*)
This is a required field. Please fill in the appropriate information.

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

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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