Apply for Hair Transplant Approval - College of Physicians & Surgeons of Alberta

Approval for hair transplantation will be granted to physicians who demonstrate sufficient education and experience in the procedures and the operation of a hair transplant practice. Those practices must also demonstrate compliance with infection prevention and control requirements, including the cleaning, disinfection and sterilization of medical equipment.

Personal identification
Name*
First Last
CPSA registration #*
Mailing address*
Address line 1 Address line 2 City Province Postal Code Country
Location of practice (if different than above mailing address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone #*
Business Fax #
Type of Practice*
- Family
- Specialty
Type of Specialty*
Education and Experience
Please attach supporting documentation.*
Attached documents must be: jpeg, png, jpg, tiff or pdf. Please do not password protect your files.
Accepted file types: jpg, jpeg, png, tiff, pdf, Max. file size: 5 MB.
Infection Prevention & Control Requirements
Has your office been inspected by CPSA’s Infection Prevention & Control Program?*

Yes

No
If yes, please indicate clinic name and number:*
If yes, please also indicate date of inspection:*
DD slash MM slash YYYY
Signature
Checking this box will act as your signature:**
I have reviewed the information in this form and confirm it is accurate.
Email*
This is the email address we will send a submission confirmation notification to.
Enter Email Confirm Email
Date*
MM slash DD slash YYYY
After clicking "Submit", you will be redirected to CPSA's Secure Payment Processing Portal to complete your payment. We require payment to begin processing your request.

After completing payment, we will email you a receipt. That receipt is confirmation that your information was received and your request will be processed.

Review fee information.
Hidden
Admin fields
Hidden
Requested Form*
Hidden
Quantity*
Please enter a number from 1 to 1.
Hidden
Are you a student?*

Yes

No
Name
This field is for validation purposes and should be left unchanged.

Personal identification

Education and Experience

Infection Prevention & Control Requirements

Signature

Admin fields

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