TPP Alberta | Report a Missing or Stolen Prescription Pad Form

To report a missing or stolen pad, please complete and submit the form below.

If your browser’s autofill is on, please review your form for accuracy before submitting. Consider disabling autofill to avoid unintended changes to your inputs.

Registrant information
Are you submitting this report on behalf of someone else?*
- Yes
- No
Your name*
First Last
Your email*
This is the email address we will send a submission confirmation notification to.
Enter Email Confirm Email
Contact phone number*
Name of practitioner*
First Last
Email of practitioner*
Enter Email Confirm Email
Practitioner regulatory body*
Regulatory body registration number*
0 of 6 max characters
Pad report details
Are you reporting a missing or stolen pad?*
- Missing
- Stolen
Date of loss or theft (should be typed in the format mm/dd/yyyy, as in 03/15/2023)*
MM slash DD slash YYYY
Date of last prescription (If known)
MM slash DD slash YYYY
Name of last patient prescribed a secure prescription (If known)
Do you know the TPP Tracking numbers of the pad(s)/form(s)?*
- Yes
- No
Tracking numbers of missing forms*
If you are reporting a series, only the start and end numbers are required.
Please provide a description of the incident*
Has this been reported to law enforcement?*
- Yes
- No
Police report information
Input all known information
Police file number Investigating Constable's Name Investigating Constable's Phone # Investigating Constable's email Detachment number Online confirmation number
Do you require a replacement pad?*
If you require a replacement pad, you will receive the link to the re-order form in your submission confirmation email.
- Yes
- No
Additional comments
Email
This field is for validation purposes and should be left unchanged.

CPSA's 2023 annual report now available

Find out about our year through stats and stories.

Registrant information

Pad report details

CPSA's 2023 annual report now available