Certificate of Professional Conduct

  • 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

    Certificate of Professional Conduct
    Authorization & Consent to Release Information

  • 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 of Professional Conduct be sent
  • (include mailing or email address)
    1. Personal Identifiers
    2. Qualifications & Credentials
    3. Prince Edward Island registration and licensure information
    4. Complaints and Registration Committee, Fitness to Practise Committee, or Board of Inquiry decisions including, but not limited to:
      • Any suspension, condition or restriction of a licence
      • Findings of Professional Misconduct, incapacity or unfitness to practise, including consensual reprimands or matters resolved by alternative dispute resolution.
      • Open complaints which have not been resolved
      • Investigations
    5. Non-disciplinary Information
    6. Other information considered relevant by the Registrar

  • MM slash DD slash YYYY
  • If you chose to pay the $125 fee by cheque or cash, your Certificate will be processed when the payment is received in the office.