Zoom for Healthcare Account Request Form

To request a Zoom account for video meetings, please complete the fields below. If you have any questions, please visit the COVID-19 Office of Virtual Health webpage or email officeofvirtualhealth@phsa.ca.

1. Requestor Information

Fields with a * are mandatory

Note: Any changes made in Section 1 after clicking the checkmark will not be reflected in Section 3: Row 1. Uncheck and recheck to refresh the data.

2. Purpose of Zoom for Healthcare account


Zoom for Healthcare accounts are intended for conducting or supporting Virtual Health Visits.

3. Individuals who require a Zoom for Healthcare account


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4. Comments