Location Onboarding Form Please complete the form below for each location to kickstart your PRAXES services! Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Location InformationIn this section, we collect some important information about your location.Location/Vessel/Project Name *Max # of people onboard the vessel or at the location? *Where is the location, or where is the vessel home port? Please include the address. *What is the primary type of location/vessel? *Fishing vesselScientific/researchPleasure Craft (Sailing or motor)Passenger Ferry or Cruise ShipIndustrial Vessel (Seismic, Oil & Gas, Shipping, etc)Land-based Industrial (Mine, Construction, etc)Land-based event (Sports, Film, Conference, etc)OtherAre Telemedicine services required for this location? *YesNoWill the location need coverage to speak to a PRAXES doctor?Telemedicine Coverage Start *Telemedicine Coverage End *Primary Phone number the location can be reached at (Normally the main Satellite Phone) *Backup Phone number the location can be reached at (Can be another Satellite phone)How will the location be calling PRAXES? (i.e. Satellite phone, Mobile phone, VOIP phone, WiFi calling, Landline, etc.) This helps our technical support team understand what technology is being used, to help support any phone connection issues.Company / Organization InformationIn this section, we collect some important information about your company/organization and your main company representative. This is the person in your company that PRAXES will reach out to for any business renewals, ongoing operational concerns, and send incident reports to when your vessel calls in for Telemedicine assistance. Company / Organization Name *Name of company representative / main business contact *FirstLastJob Title of company representative *Email of Company Representative *Phone of Company Representative *Would the Company Representative like to receive incident reports? *YesNoIncident reports are sent out anytime this vessel engaged PRAXES Telemedicine service. An alert can be sent to the Company Representative.Would you like to add a Backup Company Representative? *YesNoYou can optionally add a backup company representativeName of Backup company representativeFirstLastJob Title of Backup company representativeEmail of Backup company RepresentativePhone of Backup company representativeWould the Backup company representative like to receive incident reports? *YesNoIncident reports are sent out anytime this vessel engaged PRAXES Telemedicine service. An alert can be sent to the Backup company representative as well.Medical kitPlease upload a copy of the Medications available at your location. This is very important so PRAXES Doctors know what they can recommend and prescribe.Do you have a Medical Kit on-site at the location? *YesNoMedication Template Please use the template above to fill in a copy of the Medical Kit at your location, then upload it below: Click or drag files to this area to upload. You can upload up to 10 files. If you’re unable to use the template above, please upload your list here and we will try to import it.Information of person calling Telemed Service or Logging into Praxes ConnectWho onboard the vessel will be calling the Telemedicine Service or accessing Praxes Connect software? This is important so that we can understand their skill level/training. You can add up to 3 people. Name of Person #1. This is the primary caller or person accessing Praxes Connect at your location. *FirstLastEmail of Person #1 *Role/Job of Person #1 (Captain, Medic, Project Manager, 1st Mate, etc.) *Medical Role of Person #1 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *Is there a 2nd person that you'd like to add? *YesNoName of Person #2 *FirstLastEmail of Person #2 *Role/Job of Person #2 (Captain, Medic, Project Manager, 1st Mate, etc.) *Medical Role of Person #2 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *Is there a 3rd person you'd like to add? *YesNoName of Person #3 *FirstLastEmail of Person #3 *Role/Job of Person #3 (Captain, Medic, Project Manager, 1st Mate, etc.) *Medical Role of Person #3 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *Special instructionsAre there any special notes that you'd like to tell us? (Optional)Terms and ConditionsTerms of Use *Check this box to confirm you have read and agree with PRAXES Terms of Use.View a copy of our Terms on our website here: https://praxes.ca/termsSubmit
