Community Health Practitioners Discontinuing Access to PharmaNet

This form is for community health practitioners who are retiring or for other reasons no longer need access to PharmaNet, and who are not enrolled in PRIME.

* indicates field is mandatory

Practitioner College ID#*
Information on File
Practitioner First Name*
Practitioner Middle Name
Practitioner Surname*
Practitioner E-mail Address
Community practices where you access PharmaNet
Practice 1
Practice name
Street address
Postal code
If you access PharmaNet at more than four practices, please fill out and submit this tool a second time.
Discontinue my practitioner access to PharmaNet

For more information contact:

 HLTH 7092 - Last Revised: June 16, 2020