Zoom for Healthcare Enrollment

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Prefill with your MyPEI Account

Allow this form to use information already in your MyPEI account to fill in fields automatically. You can review and edit everything before submitting.

Health PEI’s Zoom for Healthcare licenses are available to Health PEI employees for patient-facing use or to schedule patient consults only. If you need assistance completing this form please email ehealthsupport@ihis.org.

Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01, as it relates directly to and is necessary for the provision of Zoom Licenses. If you have any questions about this collection of personal information, you may contact ehealthsupport@ihis.org.

Identification

Provide Health Care Provider name and contact details.

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Note: If you are a Health PEI Employee, use your ihis.org email address.

Manager Information

Provide information about your department head, lead and/or manager in the fields below.

First Name

Last Name

Email Address