Application for a Full Practicing License Subscription Personal Info - SCPT | Saskatchewan College of Physical Therapists

Application for a Full Practicing License Personal Info

PERSONAL INFORMATION

Prefix

Mr.

Mrs.

Ms.

Miss

Dr.

First Name *

Middle Initial

Surname *

Preferred Name

Given Name

Previous Name

Gender

Male

Female

Birth Date

Primary Address

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Home Phone

Cell Phone

Primary Email *

Alternate Email

CIHI INFORMATION

You must select Not Applicable when it does not apply to you

Province or Territory of Residence

Country of Residence

Province or Territory of Registration

Previous Province or Territory of Registration

Initial Employment in Canada in Physiotherapy

Initial Province of Canadian Employment in Physiotherapy

Year of Initial Cdn Employment in Physiotherapy

EDUCATION INSIDE PHYSIOTHERAPY

Basic Education in Physiotherapy

Graduation Date

Level of Basic Education in Physiotherapy

University of Graduation in Basic Education

Country of Graduation for Basic Education

SPECIALIZED PROCEDURES CERTIFICATION INFO

Acupuncture

Dry Needling

Pelvic Health

Manipulation

Post-Professional Manipulation

Entry to Practice Manipulation

Conditions on Practice Licence

Min. 6 characters required for username and password

Username *

Password *

Password Confirmation *