Form

Interest Form

Thank you for your interest in MedMe! The purpose of this form is to see if MedMe is the right fit for your pharmacy. Please fill out the interest form below, and we'll reach out shortly.

Please do not fill out this form if you're a patient or part of a pharmacy organization that already uses MedMe. For patients, please reach out to your pharmacy to access clinical services. For pharmacies, please contact your organization to get started with MedMe.

Contact Information

First Name*

Last Name*

Email*

Phone Number*

Job Title (Pharmacist, Pharmacy Owner ONLY)*

Licence Number*

How did you hear about MedMe*

Recommendation or referral from a peer

Partnerships with other pharmacies, chains, banners, etc.

Prior personal experience

Google/Search Engine

Conference or event

Blog

Social Media

Podcast or video

Other

Pharmacy Information

Organization/Pharmacy Name*

Number of Stores*

Website*

Are you looking to increase clinical services in your organization/pharmacy (e.g. minor ailments, vaccinations, travel consultations)?*

Yes

If yes, what clinical services are you looking to increase?

Are you looking for an end-to-end solution from scheduling to virtual care to documentation?*

Yes

If yes, what features would you like to see in an end-to-end solution?

Are you looking for other pharmacy solutions (e.g., specialty pharmacy)?*

Yes

If yes, please specify the type of solution you're seeking:

Is there anything else about your organization/pharmacy that MedMe should be aware of?

By checking this box, I acknowledge that I'm a pharmacist or pharmacy owner looking to implement MedMe at my pharmacy.*