TPP Pad Reorder Form - College of Physicians & Surgeons of Alberta

TPP pad orders received after Monday, Dec. 9, 2024, at 8 a.m. will be processed when weekly orders resume on Jan. 6, 2025.

To re-order a secure pad, please complete and submit the form below. Please note, P.O. boxes, home addresses, or out-of-province addresses are not permitted for deliveries.

Name*
First Last
Are you submitting this order for yourself?*
- Yes
- No
Name of Prescriber*
First Last
Email of Prescriber*
Enter Email Confirm Email
Email*
This is the email address we will send a submission confirmation notification to.
Enter Email Confirm Email
What regulatory body are you registered with?*
Regulatory body registration number*
Do you require a locum pad?*
Only your name and no addresses will be imprinted on TPP secure forms.
- Yes
- No
How many pads do you require?*
- 1
- 2
Clinic Name*
Clinic Address*
Address Line 1 Address Line 2 City Province Postal Code
Clinic Phone Number*
Shipping Address*
Same as clinic address

Address Line 1 Address Line 2 City Province Postal Code
Contact Phone Number
If different from clinic phone number
Special Instructions
Email
This field is for validation purposes and should be left unchanged.

TPP pad orders received after Monday, Dec. 9, 2024, at 8 a.m. will be processed when weekly orders resume on Jan. 6, 2025.

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