Current Page 1 Page 2 Preview 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