GENCAN PHONE: 1-866-501-3338                           GENCAN FAX: 1-800-497-9592

 

If you are a Healthcare Provider and would like to initiate Gen-clozapine therapy, please complete a Patient Registration Form and fax it to GENCAN.
 

Once Registered, you will have access to the GenCAN™ database, which will assist you in the Monitoring of your Patients.  CLICK on one of the buttons below to download.

 

Patient Form


 

Proxy User Registration Form


Blood Reporting Form

   

Patient Registration Form is used for:

        Registering a Patient  - new or switched from another brand of clozapine

        Modifying any information for a Patient who is registered with GenCAN™

        Pharmacist Registration (or modifying an existing Pharmacist’s Information)

        Physician Registration (or modifying an existing Physician’s Information)

Proxy User Form is used for:

        Registering a Proxy User who requires access to the GenCAN™ database

Instructions for downloading:

Select the appropriate form and save the pdf file to your computer. Once you have printed and completed the form, return VIA fax to 1-800-497-9592.

Adobe Acrobat is required to view and print these files. If you do not have Acrobat installed on your computer, please click the link below to download and install the software.

 

 

   

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