Zoom for Healthcare Enrollment

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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