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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.


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.