Welcome! Please specify whether you are a patient or caregiver, then fill out the form below to register. *

Caregiver Information

Caregiver Residing Address

Patient Information

Residing Address

Shipping Address

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SUBMIT MEDICAL DOCUMENT

Thank you for signing up. Your account has been created and is pending approval. In order to complete your registration, please submit your medical document through one of the options below:

Mail to

PO Box 51
Peers, Alberta
T0E 1W0

Via Secure Fax

Have your Medical Practitioner fax your medical document to: 1-888-693-0150