Certificate of Conduct Application


  • The College of Physicians and Surgeons
    Of Prince Edward Island


    14 Paramount Dr.
    Charlottetown, PE C1E 0C7
    Phone: (902) 566-3861
    Fax: (902) 566-3986
    Website: www.cpspei.ca


    Application Form
    Certificate/Letter of Standing


    Date:

  • a physician licensed presently or formerly by the College of Physicians
  • and Surgeons of Prince Edward Island or its predecessor, the Medical Council of PEI, request that a Certificate (Letter) of Standing be sent
  • .

  • I acknowledge that such Certificate or Letter will include particulars of:

    1. Complaints and Registration Committee, Fitness to Practice Committee, or Board of Inquiry decisions including:
      • Any suspension, condition or restriction of a license
      • Findings of Professional Misconduct, incapacity or unfitness to practice, including consensual reprimands or matters resolved by alternative dispute resolutions.
      • Open complaints which have not been resolved
    2. Dates and details of registration and licensure in Prince Edward Island
    I further acknowledge that, if requested by the licensing authority specified above, further elaboration of the above information may be provided by the College of Physicians and Surgeons of Prince Edward Island, without further consent, provided such request is received within one year following the date of this application.
  • MM slash DD slash YYYY