Psychedelic-Assisted Psychotherapy – Register a new facility

Before CPSA can accredit your facility to provide psychedelic-assisted psychotherapy, we first need to perform an assessment.

Please complete this form to register for an assessment. You’ll need to provide information about:

  • your facility’s owner, location, hours of operation and records keeping
  • personnel, including the facility’s medical director
  • other physicians providing care, personnel administering psychedelic drugs and monitoring patients, and personnel providing psychotherapy
  • descriptions of services provided, including psychedelic drugs currently in use

Once we’ve received your submission, we’ll be in touch to provide details about next steps.

  • General Facility Information

  • Days/hours of operation

  • Integrated electronic health records

  • Personnel

  • Medical Director

  • Facility contact

  • Financial contact (if applicable)

  • Other personnel

  • Click + to add a row
    NameCPSA registration #FT/PT/Casual 
  • Click + to add a row
    NameQualification (e.g., RPN, ACP)Respective college (e.g., CARNA, CRPNA)Registration #FT/PT/Casual 
  • Click + to add a row
    NameQualification (e.g., RPN, Psych)Respective college (e.g., CARNA, CRPNA)Registration #FT/PT/Casual 
  • Services

  • Click + to add a row
    Psychedelic drug(s) currently in use# of patients seen each month 
  • Medical Director's Signature

  • MM slash DD slash YYYY
  • Privacy Notice: This information is being requested under the authority provided by Section 8.2(3) of Schedule 21 of the Health Professions Act. CPSA collects, uses and/or discloses your personal information with your consent or as authorized or required by law and in accordance with our Privacy Statement. We collect and use your personal information in order to support the business of CPSA, specifically to protect the public and guide and regulate our members.
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Questions about filling out this form?

Toll-free: 1-800-561-3899 (in Canada)
Fax: 780-424-5859

  • This field is for validation purposes and should be left unchanged.