Accreditation Program Assessor Application

The College of Physicians and Surgeons of BC (CPSBC) collects, uses, discloses, stores, and retains personal information under the legal authority of the Freedom of Information and Protection of Privacy Act (FIPPA), RSBC 1996, c.165 and the CPSBC Bylaws made under the Health Professions and Occupations Act (HPOA), SBC 2022, c.43.

The personal information collected on this form is permitted under sections 26(c) and (e) of FIPPA for the purpose of processing your application.

If you have any questions or concerns about CPSBC privacy practices, please email privacy@cpsbc.ca.

Applicant information

Name: (as it appears on driver's licence or passport)

*Given name(s):

*Last name:

*Credentials:
Select the program you are applying to be an assessor for and then select your credentials.

*Diagnostic Imaging (check all that apply):

MD
RTR
RTNM
RDCS
CRVS
RTMR
RDMS
CRGS
CRCS
Other:

*Laboratory Medicine (check all that apply):

MD
PhD
RT
ART
Other:

*Neurodiagnostics (check all that apply):

MD
FRCPC
RET
REPT
EPT
RTEMG
Other:

*Polysomnography (check all that apply):

MD
RPSGT
CPSGT
HSAT
Other:

*Pulmonary Function (check all that apply):

MD
FRCPC
RRT
CACPT
Other:

*Non-Hospital Medical and Surgical Facilities Accreditation Program (check all that apply):

Surgeon
Anesthesiologist
Registered nurse
Medical device reprocessing technician or equivalent
Clinical embryology/andrology