Location Onboarding Form

Please complete the form below for each location to kickstart your PRAXES services!

A location can be considered as a worksite, vessel, or clinic depending on your industry. For any additional locations, the following linked template can be used and uploaded in the file area below.

Onboarding Form – Additional Locations

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Company / Organization Information

In this section, we collect important information about your company / organization and your main contact representative. This person in your company is whom PRAXES will communicate with for business renewals, ongoing operational concerns, and provide incident reports to when your location calls for Telemedicine assistance.

Company / Organization Name

Company Representative Name:

First

Last

Job Title of Company Representative:

Email Address of Company Representative:

Phone Number of Company Representative:

Does the Company Representative want to receive Incident Reports?

Incident reports are sent to the Company Representative via email anytime your locations engage our Telemedicine service.

Would you like to add a Secondary Company Representative?

You can optionally add a Secondary Company Representative.

Location Information

In this section, we collect important information about your location.

Location / Project Name

Maximum Number of People On-Site / On-Board Requiring Coverage at a Given Time?

Includes Staff, Crew, Guests, Visitors, Passengers, Patients, etc.

Location Details:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

For vessels, please provide the location of the home port.

Location Industry Type?

Are Telemedicine Services Required for this Location?

Primary Phone Number for the Location?

Normally the Main Satellite Phone Used for Expeditions / Adventure Travel, Remote Worksites, or Vessels.

Secondary Phone Number for the Location?

Can be Another Satellite Phone.

Preferred Country / Region Code for your PRAXES Telemedicine Call-In Phone Number?

UK / International
USA
Canada

For example, we can set up a UK Phone Number for calling PRAXES.

Medical Kit Information

An On-Site Medical Kit at each location is essential for our Telemedicine services. It is very important that our PRAXES Doctors know what they can recommend and prescribe.

Do you have an Existing Medical Kit at this Location?

Yes
No, I have requested a new PRAXES Medical Kit

Please upload a copy of the Medications currently available at your location in the file area below, using the following linked template:

Medical Kit Medication Inventory

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

If you’re unable to use the linked template, please upload your list in the file area above and we will attempt to import it.

Billing Information

In this section, we collect information about your company / organization’s billing information and your main finance contact. This person in your company is whom PRAXES will communicate with and send invoices to.

Finance Contact Name

First

Last

Finance Contact Email Address

Secondary Finance Contact Email Address

Billing Details:

Company Name:

Address