Tell us a little bit about yourself.

Let’s start with learning more about you and your pharmacy!

*Please Note: This form will NOT be submitted if ALL the required (*) fields are not filled out.

ADMINISTRATOR ACCOUNT INFORMATION

You will use this to information to log into your MedMe account.

First Name*Preferred Username

Last Name*

Email Address*

Cell Phone Number

PHARMACY INFORMATION

This information will be shared with patients and displayed to the public on your MedMe site.

Pharmacy Name*Pharmacy Fax Number

Pharmacy Email Address*Pharmacy Website

Pharmacy Phone Number*

Pharmacy Address*

Unit NumberCity*

Street NumberProvince/State*

Street Name*Postal Code/Zip Code*

Let's customize your MedMe site.

We’ll use this information to customize the domain for your pharmacy!

*Please Note: This form will NOT be submitted if ALL the required (*) fields are not filled out.

SET UP INFORMATION

You will use this to information to log into your MedMe account.

Preferred Subdomain Extension*

.medmeapp.ca

This will be a part of the URL link for your MedMe website.

Preferred Activation Date*

This will be when you’d like to start using MedMe (please enter a date at least one week after today!)

Banner Association*

If you are NOT associated with a banner pharmacy, please send your pharmacy's logo right after you sign up to care@medmehealth.com to show on your MedMe site!

Pharmacist Association Coupon ID (Optional)

If you have received a coupon from your pharmacist association, please enter it here to take advantage of your preferred pricing.

Select a pricing plan.

Select a pricing plan that fits your needs.

*Please Note: This form will NOT be submitted if ALL the required (*) fields are not filled out.

Which pricing plan would you like to go with?* (See Pricing Plans for more detail)

FREE

Please contact us at care@medmehealth.com

MONTHLY

ANNUAL

Which add-on modules/features would you like enabled?

All Add-on Modules

Virtual Care

Which add-on modules/features are you interested in once they are released?

Follow Ups

Patient Transfers + Service Flagging

Which add-on modules/features would you like enabled?

COVID Testing

Minor Ailments - Ontario

Medication Review

Travel Consultations

Virtual Care

Which add-on modules/features are you interested in once they are released?

Patient Transfers + Service Flagging

Pharmacogenomics

Point of Care Testing

Follow Ups

Are you an enterprise?
MedMe offers custom pricing and features for enterprises. Please contact care@medmehealth.com to learn more!

Do you have a referral code? (Optional)
If you have received a referral coupon code from other pharmacies, please enter it here to enjoy $50 credits to your account! (Learn more about the referral program)

*I confirm that I have read and agree to the MedMe SaaS Agreement*I confirm that I have read and agree to the MedMe Privacy Policy

module

features

Back

Next

Enter your billing information.

One more step! At the end of the month, you will be billed according to chosen pricing plan and added modules/features.

After clicking "Pay Here", you will be redirected to our secure platform where you can enter your billing information. Please note that there will be a $0.50 activation fee that will be refunded shortly.

Oops! Something went wrong while submitting the form.