New Dragon Medical One User Registration

Canadian Clinics

If inclined, please use this form if you are a multi-physician clinic in Canada with an established relationship with Speakeasy Solutions.

Otherwise, email the same information.

Note

If you encounter any issues with this form, please email directly or telephone at 1-888-964-9109 ext. 102.

Please fill in ALL fields except Additional Notations unless needed.

Thank you.

If the SEND button remains after clicking it and you do NOT receive a confirmation message,
there is a blank field above (not including Additional Notations) that needs to be filled out. Thank you.