Medical Cannabis by Shoppers Drug Mart Inc. 6941 Kennedy Road, Unit 100 Mississauga, ON L5T 2R6 www.shoppersdrugmart.ca/cannabis Fax: 18662202627 Tel: 18446332627Medical DocumentTo be completed by.
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How to fill out the Shoppers Drug Mart Registration online
This guide provides a comprehensive overview of how to complete the Shoppers Drug Mart Registration for medical cannabis. It is designed to assist users in filling out the necessary information accurately and effectively.
Follow the steps to complete your registration.
- Click ‘Get Form’ button to access the registration document and open it in your preferred editor.
- Begin filling out the patient information section. Ensure that the first name, last name, diagnosis or condition, date of birth (formatted as mm/dd/yyyy), daily quantity (in grams), and period of use (in grams per day) are completed. Confirm that the information matches the Patient Registration Form.
- Select the gender designation by marking either the 'Male' or 'Female' option as appropriate.
- Complete the healthcare professional information section. Fill in the first name, last name, authorized province of practice, clinic name, profession, clinic address, postal code, city, and telephone number.
- Indicate the method of consultation by selecting either 'In person' or 'Telemedicine'.
- Provide the healthcare professional's license number and address. Complete the location of consultation information with the province, city, and postal code.
- Confirm agreement to receive the patient's medical cannabis delivery at the business address by marking the corresponding checkbox.
- Affirm the accuracy of the provided information by signing and entering the date (formatted as mm/dd/yyyy).
- If faxing the completed document, acknowledge that the faxed document is the original. Retain a copy for personal records by providing your initials.
- Finally, for healthcare professionals, fax the completed document directly to 1-866-220-2627. For patients, either drop off the completed document at a local Shoppers Drug Mart or mail it to the specified address in Mississauga, ON.
Begin completing your Shoppers Drug Mart Registration online today.
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