Register online for our free service

Registration Form - Hospital Program

Register for our service - completely free for hospitals

Please take a moment to complete the form below to confirm your participation in the program. Under hospital regulations, a signed service agreement will also be requested after registration. You may cancel the program at any time.

Our Privacy Statement

The information on this form will be used strictly for registration purposes and will NOT be shared with any third-party organizations.

Contact Information

* indicates a required field
Name of Hospital*:
Contact Name*:
Hospital title/ position:
Hospital Mailing Address*:
 
City: *
Province: *
Postal code: *
Daytime telephone: * must be 10 numbers in length - -
Fax number: - -
Email address*:

Hospital Information
Proposed number of waiting room locations (for units)*:

Agreement

By submitting this form, I, the contact person listed above, understand that IDS Canada will be contacting me to discuss the service agreement and to arrange an installation date. I am aware that the program is free and there are no charges for this service. The display unit remains the property of IDS Canada.

For further information regarding the Hospital program, please contact us toll-free at 1-877-656-9996 or e-mail at info@idscanada.info