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?*

Name

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

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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