Return to Practice - College of Physicians & Surgeons of Alberta

This assessment helps prepare physicians, previously registered in Alberta, to safely return to practice after an absence of three or more years.

Applicant information

Name of applicant:*

Given name(s) Last name

Email*

Enter Email Confirm Email

CPSA registration #:*

Phone number:*

How many months have you been out of practice in Alberta?*

What was your scope of practice prior to your absence?*

Within the past three (3) years, have you undergone formal training related to your proposed return to practice area?*

Are you planning on taking formal training relating to your proposed return to practice area?*

In your proposed return to practice area will you be practising in a group practice or hospital setting?*

Checking this box will act as your signature:*

I confirm I am the applicant and that information in this form is accurate.

Date*

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For CPSA use only

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QUEST Library

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Document Type

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Document Name

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Issuer

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Recipient

Comments

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