Notification of Change Form

Before you begin

Please review each section and update your information before you submit this form. For additional information on CPSA’s expectations about changes to your practice, see our standards on:

• Relocating a Medical Practice
• Closing or Leaving a Medical Practice (including retirement)

Are you on the Provisional Register and require ongoing sponsorship?

If you are reporting changes to your practice locations that are different from the ones you were sponsored for, your sponsor must approve these changes and submit the Change to Physician Sponsorship Form. This form must be completed and signed by your sponsor before we can process your requested changes.

Are you a CPSA assessor, reviewer or sit on a CPSA Committee?

If you would like to change your address for accounting purposes, please email accounting@cpsa.ab.ca.