Application Forms for CytoBase for Clinicians

Inscyte is pleased to provide you with the application forms to register to access the CytoBase for Clinicians web site.

There are two types of application forms,Provider and Delegate.

The Provider form is for the provider of medical service, who is responsible for the patient; the Delegate form is for any delegate staff who access CytoBase for Clinicians on the Provider's behalf.

The protection of the privacy of patient information is of the utmost importance and is effected by both policy and technology. In this regard it is important that the registration application forms are completed fully. Please ensure that the following are included on the Provider Application:

• A copy of a photo-identification (e.g. Hospital ID or photo driver's license).
• Your CPSO License Number
• Your OHIP Physician number
• Your Liability Insurance Carrier (e.g. CMPA) and Policy Number.

The application form is signed and dated. Please ensure that the following are included on the Delegate application: ¨ The Provider's Name, CPSO License Number and signature as sponsor of the Delegate.

Application Forms
Click on the appropriate application form to download

Application for Clinicians

Application for Authorized Staff