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Prescriber 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:(*)
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Last Name:(*)
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Clinic name (if applicable)
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Address:(*)
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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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Clinic/Prescription Information:

Number of prescribers within your clinic (if applicable):
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Number of patients (approximately) per week:
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Which EMR is used in your clinic?(*)
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specify "Other" EMR:
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How do you generate prescriptions?(*)
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Do you codify drugs?
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Do you use free form text ?
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How are your patients' prescriptions delivered to their pharmacies?(*)
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Is there any other information you would like to share with us?
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