Healthcare Provider Registration
Would you kindly take a few moments to update your contact information:

This form is for practicing healthcare providers only.

* indicates required

Healthcare Provider information update *

Title *

OHIP/MSP Billing Number *

Primary Specialty *

Secondary Specialty *

Email *

First Name *

Last Name *

Clinic/Practice/Hospital Address *

City *

Postal Code *

Province *

Office Phone *

Office Fax: *

I am currently practicing at this location *

Language Preference * EnglishFrench

Yes, I would like to receive communications from LifeLabs relating to products, service, promotions, events, special offers and surveys that may be of interest to me. I may withdraw my consent at any time.

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