Request Account

Fill out form below to request account set-up

First Name *

Last Name *

Please add the Clinic Name

Address 1: Name *

Address 1: Telephone 3

Address 1: City

Address 1: Street 1 *

Address 1: Street 2 *

Address 1: ZIP/Postal Code *

Province

Primary Email *

Email Address 2 *

Mobile Phone *

If you are a multi-site clinic, please register the address for one clinic and email us at logistics@dynacareconnect.ca for assistance.

Are you currently a Dynacare client?

I would like to receive information about Dynacare product and services