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 Clinical Imaging NetworkOntario 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 EmailThis field is for validation purposes and should be left unchanged.
