Nurse Practitioners Subscribe

Subscribe to the Pharmilink Program for Nurse Practitioners

Please complete our on-line Membership Registration:
Fields marked with an asterisk (*) are required.

First Name*

Last Name*

Clinic Name

Nurse Practitioner Licence*

Graduation Year*

Therapeutic Areas of Interest*

Note: Your subscription address must match the address on file with your respective Provincial College.

Address*

City

Province*

Postal Code*

Language *

English* French*

Phone*

Email ¹

Fax

Please indicate area of specialization if applicable:

How many patients (on average) do you see in one week?

¹ If you are not registered with our program and are a nurse practitioner in active practice, who sees patients on a regular basis at an office address in Canada, you may fill out an application to become a member of the Pharmilink™ program. Once verified, you will then receive, via email, all the necessary information to allow you to place your first order.
¹ By providing your email address you are giving your express consent to receive email communications from Pharmilink Healthcare Marketing Services.
¹ You will have the option to opt-out at any time. We will always treat your personal information with the utmost respect. For more information, see our Privacy Policy

Please be assured that all information will be held in the strictest confidence.