BC Cancer LBC Pap Test - System Registration Form

BC Cancer LBC Pap Test - System Registration Form

THIS IS NOT AN ORDER FORM - THIS IS STEP ONE OF THE CLINIC REGISTRATION PROCESS.

Entering your information in this form does not mean that an order is being placed. This is a registration form to enroll your clinic for online ordering on the BC Cancer Cervical Cancer Screening Lab (CCSL) ordering website. You will be contacted by email within one business day to complete the registration.

HPV kits will be available to order online from January 29th, 2024. You do not have to re-register your clinic on the portal. Please use your existing username and password.

The online system to place an order for supplies located at https://bccancer.silverbacksystems.io (We recommend that you bookmark this link)

We require accurate information about your clinic and the staff members responsible for ordering supplies. Please complete the information below and you will receive an email registration invitation to your designated email address.

Supplies Ordering Contact Name*

Clinic Name*

Full Name of Clinic including unit or floor as applicable

Are you a Naturopathic Clinic?*

Select

Number of Clinicians*

How many Clinicians will you be ordering for?

Will you be placing orders for Clinicians individually or as a Clinic?*

If ordering individually, each Clinician should be set up as a separate delivery address. Please contact us for any assistance required

(e.g. Seymour Health Centre - Dr John Smith)

Select

Delivery Address*

Delivery City*

Delivery Postal Code*

(Do not include spaces)

Health Authority*

Which Health Authority is your primary practice located in?

Select or enter value

Telephone*

Where possible please provide a direct telephone number for Clinic Supplies Manager to avoid unnecessary wait times.

Email*

Email address of person or group responsible for ordering supplies

Secondary Email (as applicable)

Secondary Contact requiring access to supplies ordering

Test Ordering Quantities

Collection vials have an expiration of approximately 2 years. In order to provide you with appropriate supply options, please indicate from the following:

Select

Patient Sample Return*

Please select your current method of returning samples to the CCSL

Select

Clinic Hours of Operation for deliveries (weekdays)

Please indicate any days that your clinic will be closed or unable to accept deliveries. Deliveries will be made Monday to Friday during standard courier business hours.

LBC Only - Have your Clinicians received training for this product?*

Prior to submitting your first LBC samples, Clinicians should review LBC Pap Sample Collection Training materials posted on the BC Cancer CCSL Website at:

http://www.bccancer.bc.ca/health-professionals/clinical-resources/laboratory-services/cervical-cancer-screening

Select

Notes (as applicable)

Please include any further information that we should know about your clinic

Contact Us!

Should you require any assistance in completing this information, please do not hesitate to contact us. We can be reached by telephone at 604-332-4694 or by email helpdesk@silverbacksystems.io

You can find more information on the Lab’s website: http://www.bccancer.bc.ca/health-professionals/clinical-resources/laboratory-services/cervical-cancer-screening

Source

Online Form

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