Given name is required
Surname is required
Please provide valid (MM/DD/YYYY) date of birth
Valid email is required
Invalid phone #, format should be 1(xxx)xxx-xxxx
Invalid number
Required
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When applicable, make sure to include complete Civic/Street address, SITE, COMP, PO BOX, RR, GD and STN/RPO.

See Canada Post Addressing Guidelines for more information.

Physical Address
Address is required
Address is required
City is required
A choice is required
Valid postal code is required, 6 characters with following pattern "A9A9A9"
Mailing Address
Address is required
City is required
A choice is required
Valid postal code is required, 6 characters with following pattern "A9A9A9"
Shipping Address
Address is required
City is required
A choice is required
Valid postal code is required, 6 characters with following pattern "A9A9A9"
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This area is required for patients with caregivers. If this section does not apply to you, please click “Next” button to proceed to the next section.

A caregiver is a designated person who is responsible for the patient and/or applying on behalf of the patient.

Important: caregiver must be physically present to complete registration.

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Primary Caregiver
Given name is required
Surname is required
Please provide valid (MM/DD/YYYY) date of birth
Required
Valid email or phone is required
Valid phone or email is required, format should be 1(xxx)xxx-xxxx
Caregiver #2
Given name is required
Surname is required
Please provide valid (MM/DD/YYYY) date of birth
Required
Valid email or phone is required
Valid phone or email is required, format should be 1(xxx)xxx-xxxx
Caregiver #3
Given name is required
Surname is required
Please provide valid (MM/DD/YYYY) date of birth
Required
Valid email or phone is required
Valid phone or email is required, format should be 1(xxx)xxx-xxxx
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  • The applicant acknowledges that cannabinoids have not been approved for use as a drug in Canada, that its indications, safety and risks have not been adequately studied and the appropriate dosage is unclear.
  • The applicant acknowledges and agrees that he or she is using any cannabinoid product obtained from ZYUS Life Sciences Inc. (ZYUS) at his or her own risk and releases ZYUS, its affiliates, providers, directors, officers and employees from any and all actions, claims, complaints and demands for damages, loss or injury whatsoever arising directly or indirectly as a consequence of the use of cannabinoids obtained from ZYUS.
  • The applicant ordinarily resides in Canada.
  • The information in this application and medical document or registration certificate is correct and complete.
  • The medical document has not, to the knowledge of the applicant been altered.
  • The medical document is not being used to seek or obtain cannabinoids from another source.
  • The applicant intends to use any cannabinoid products supplied to them on the basis of this application only for their own medical purposes.
  • The applicant consents to ZYUS’ collection, use and disclosure of personal information contained in this patient registration form, medical document or registration certificate (if applicable), in order to complete registration of the applicant and communicate with the healthcare practitioner named in the medical document, licensing authorities and ZYUS’ service providers, in accordance with ZYUS’ privacy policy and applicable laws.
  • If the applicant has a specified K number on this application, the applicant consents to ZYUS sharing personal details and information contained in this application with Veterans Affairs Canada or the applicant’s insurance provider.
  • The applicant consents and permits ZYUS to send product and registration information to the physical addresses identified in the patient registration form, and communicate with the applicant via email regarding registration status, product availability, order status, and other matters in accordance with ZYUS’ privacy policy.
Required
Valid signature required
Sign with finger or mouse above
Sign with finger or mouse above
Valid signature required
Sign with finger or mouse above
Valid signature required
Sign with finger or mouse above
Valid signature required
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A ZYUS team member will be in contact with you at .

An email has been sent to . Please follow the instructions in the email to complete your registration.

Registration: 3 Easy Steps

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We're here to help! Contact ZYUS' Patient Care team if you have any questions and/or require further assistance.

Please contact our Patient Care Team with any question or concerns. We're here to help.

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If you choose to complete the downloadable forms, here is how to send the documents to ZYUS:

  • Secure fax: 1-877-226-5909
  • Email: care@zyus.com
  • Registered Mail:

    ZYUS
    Patient Care
    204 - 407 Downey Road
    Saskatoon, SK S7N 4L8

Please be advised we only accept original documents, not photocopies or scanned copies if sending via registered mail


Registration Changes and Updates

Patients may use the Application to Amend Registration Form to update and make changes to the original application.


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Registration Renewal

For returning patients or patients interested in renewing their registration with ZYUS, please contact ZYUS’ Patient Care Team for further assistance.

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