Application for Special Licence under Cross Border Services MOU

The Memorandum of Understanding (MOU) agreement makes it easier for licenced physiotherapists who are registered in one Canadian jurisdiction to obtain certificate of registration to practice in additional jurisdictions in order to provide continuing care or physiotherapy services that are not otherwise available, whether the services are delivered in person or via tele-rehabilitation.

Applicants for a special licence under MOU must fill in and submit the form below, including uploading applicable document(s) - Proof of Professional Liability Insurance, and a Letter of Good Standing from their present college.

Upon receipt of the form information, the documents and payment, we will review your application and you will be contacted shortly.

After you submit the form, you will be directed to the payment page - special license fee is $25.

If necessary, please contact us for more information.

Special License under Cross Border Services MOU — Application Form

Personal Information

Name
First Language
Date of birth
Email
Address
City/Town
Province/Territory
Postal Code
Home Phone
Work Phone

Present Place of Employment

Workplace Name
City/Community
Province/Territory

Intended Work Site and Dates

Workplace Name
City/Community
Province Prince Edward Island
Dates of Anticipated Practice on PEI

Physiotherapy Licence

Currently Licensed?
Licence Number

Supporting Documents

Proof of Professional Liability Insurance .jpg or .png images or .pdf files, not exceeding 5MB in size, are accepted
Letter of Good Standing from Present College .jpg or .png images or .pdf files, not exceeding 5MB in size, are accepted

Declaration

By submitting this form the applicant declares the following

I declare the information given on this form to be correct and complete to the best of my knowledge.

Are you a real person? (no robots please)

Please answer the following question:
What do you call a man made out of snow?
Your answer

PEI College of Physiotherapy

Application for Special Licence under Cross Border Services MOU

Special License under Cross Border Services MOU — Application Form

Contact Information