Request Certificate

Request a Certificate of Professional Conduct

Request a Certificate of Professional Conduct

You may request a Certificate of Professional Conduct (CPC) if you hold, or have held, registration to practice medicine in
Prince Edward Island.

"*" indicates required fields

I,*

of*

a physician registered presently or formerly by the College of Physicians and Surgeons of Prince Edward Island or its predecessor, the Medical Council of PEI, request a Certificate of Professional Conduct be sent to:

to*

(include mailing or email address)

Date*

Physician Mailing Address*

Street Address Address Line 2 City Province Postal Code

Physician Email Address*

Physician Signature*

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.

Will you be paying online?*

The Certificate of Professional Conduct will be sent to the regulatory authority or healthcare institution marked on your
consent form. Typically, these requests are completed within 5 to 10 business days from the date we received your
request.

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