Get Revaid

Filling out the Revaid prescriber registration form is an essential step for healthcare providers wishing to prescribe ®, ®, or ®. This guide will help you navigate the process efficiently and accurately.

Follow the steps to fill out the Revaid prescriber registration form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editing tool.
2. Complete the prescriber information section including your name, license number, province, and specialty.
3. Fill out your primary contact information, ensuring to include the street address, city, province, telephone number, fax number, postal code, and email address.
4. Provide details for a secondary contact person, such as a nurse or office administrator, including their name and contact information.
5. Review the consent statement carefully and ensure you understand the implications of compliance with the RevAid® program.
6. Sign and date the form, confirming you have completed all required fields accurately.
7. Submit the completed form by faxing it to 1-877-585-2382 or mailing it to the designated address 70 Wynford Dr., PO Box 383, North York, ON, M3C 2S7.
8. Keep a copy of the submitted Prescriber Registration Form for your records.

Complete the Revaid registration process online to become a registered prescriber today.