eReferral Specialist Onboarding Form

Before you Continue

This form requests Onboarding Services for a clinic that is not currently using Ocean.

If you are looking for Technical Support, need help onboarding a single user to an existing Ocean site, Training, or have any other inquiries regarding Ocean, please use the

General Inquiries & Technical Support Form: (https://www.referralsns.ca/ask)

Date*

Your Name (Submitted By)*

Clinic Name.

What is your practice specialty?*

Clinic Administrator/Contact Name*

Clinic Administrator/Contact Email*

Clinic Administrator/Contact Phone*

Phone

Specialist(s) Name*

Specialist(s) Email*

Which EMR do you currently use?*

Select or enter value

Do you share an EMR with other providers?

Select or enter value

Send me a copy of my responses