ENITS Account Management Last name of applicant* First name* CPSO# or CNO#* PositionStaffResidentFellowPrimary contact email (No GMail or Hotmail Accounts please)* Primary contact phone*Extension (optional) Admin email (if applicable) Please select* HospitalCambridge Memorial HospitalCHEOCritiCall OntarioGuelph GeneralHamilton Health SciencesHealth Sciences NorthHumber RiverKingston Health SciencesLondon Health SciencesMacKenzie HealthOntario Telemedicine NetworkOttawa HospitalOttawa Heart InstitutePeterborough Regional Health CentreRoyal Victoria Regional Health CentreHospital for Sick ChildrenScarborough-Rouge HospitalSouthlake Regional HospitalUnity HealthSunnybrook HospitalThunder Bay Regional Health Sciences CentreTrillium Health PartnersUHN/TWHWilliam Osler Health SystemWindsor Regional Hospital Specialty Registration Authority E-mail coordinates Request Type* Request for new account Modification to existing account Re-Enable existing account Disable existing account Deletion of existing account CommentsThis field is for validation purposes and should be left unchanged.
