Step 1 of 5
Please complete the following appointment application.
Make sure you have proof of your documentation, membership with the Canadian Medical Protective Association (CMPA) or evidence of professional liability insurance coverage to submit with your application as you will be asked to upload. (Group Health Centre provides a copy of their physician’s insurance coverage therefore GHC physicians do not need to attach)
You will not be able to save this application and return to add your documentation.
Diplomas, Certificates, Degrees, Fellowships, etc.
Internships, Residencies, Research Fellowships, etc. in reverse chronological order
Past and Present
(1) A listing of all privileges held while a member of the medical staff;
(2) The term and nature of my appointment;
(3) Identification of any offices or appointments held; and
(4) Identification of any circumstances related to any disciplinary measure imposed against me while a member of the medical staff, including the suspension of privileges for whatever reason.
In accordance with the Authentication Electronic Signature Policy in the Administration Manual on Authentication/ Electronic Signature which I have read, all reports which I dictate will be considered authenticated on the basis of my signature below, the utilization of my unique three digit dictation I.D. code, and the statement of my name at the beginning of each piece of dictation, unless otherwise indicated. The electronic signature will be considered replacement of my hand-written signature for electronically generated reports/orders by utilization of my sign-on and password. It is the responsibility of the dictating individual to read the transcribed report. If an edit is required, the corrections must be made in writing on the original and returned to the appropriate department, or an addendum must be dictated. Refer to policy Authentication Electronic Signature Policy.
Dec 20th-23rd 9:00 AM-5:00 PM
Dec 24th Closed
Dec 27th Closed
Dec 28th-31st 9:00 AM-5:00 PM
Jan 3rd Closed
Jan 4th-7th 9:00 AM-5:00 PM
Happy Holidays!