Sign Up - ACT Medical Diagnostics

Please complete this form if you are a licensed Healthcare Practitioner within Canada, are permitted to order laboratory testing in the province in which you do business and do not currently have an account with Genova or ACT Medical Diagnostics.

Once we verify your eligibility, we will respond with an account number which you can then use to create an online profile and begin ordering tests. If you have any questions or problems, get in touch. We’d be very pleased to help you get started.

If you already have a Genova account number, you can register here for online access.

Company
This field is for validation purposes and should be left unchanged.
Practitioner Details
First Name*
Last Name*
Degree(s)*
Proof of License
Max. file size: 512 MB.

Be sure to include an electronic copy of the ordering Healthcare Practitioner's license that shows the expiration date or a copy of a voided prescription pad form to ensure the quickest turnaround time.
Email Address*

An Email address is required to establish your online account. Via our portal, you will have access to your account online, you will be able to order kits, and most importantly, you will have access to your full-color, PDF patient results.
Office or Clinic Name*
Phone Number*
Clinic Address*
Please include postal code
Name
Title

Practitioner Details