Zoom 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 account (e.g. patient appointments, education, staff meetings)


3. Individuals who require a Zoom account


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4. Comments