Location Onboarding Form – PRAXES Medical Group

Please complete the form below to onboard a new location for telemedicine services. Note that this form should be completed for each location that needs to be set up.

*Fields with an asterisk are required.

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Location Information

In 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?

Are Telemedicine services required for this location?

Will the location need coverage to speak to a PRAXES doctor?

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.

Location/Vessel Photo

This helps provides some context for the PRAXES Doctors when providing medical advice.

Do you have a photo of the location/vessel that you can provide?

Company / Organization Information

In 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

First

Last

Job Title of company representative

Email of Company Representative

Phone of Company Representative

Would the Company Representative like to receive incident reports?

Incident 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?

You can optionally add a backup company representative

People Covered

In this section, you can upload a full list of all of the people that will be covered by PRAXES Telemedicine. Ideally this is a spreadsheet and has First Name, Last Name, Sex, Role on Vessel and Date of Birth.

Do you have a list of the people that will be covered?

Medical kit

Please 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?

Medication Template

Special instructions

Are there any special notes that you'd like to tell us? (Optional)

Terms and Conditions

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://legacy.praxes.ca/terms