Certificate of Professional Conduct

CPSM Practice Direction, Article 2.22 prescribes the form of certificate of professional conduct (CPSM Practice Direction – Schedule B) issued by this College.  Article 2.23 provides that the Registrar shall only issue the certificate upon receipt of the written consent of the member and payment of the fee for issuance of the certificate.

You must submit a signed consent form.  The certificate will be issued upon receipt of the signed consent form and payment of the fee(s) $105.00.  Note that the consent and payment form may be submitted by fax, email or regular post.

Please allow up to 10 working days for a Certificate of Professional Conduct to be sent to the organization(s).  There is an additional $5.25 faxing fee to fax the certificate.

The following organizations are exempt from the faxing fee:

  • College(s) of Physicians & Surgeons of BC, AB, SK, ON, NS, NB, PEI and NL
  • Collège des médecins du Québec
  • Yukon Medical Council
  • Government of the Northwest Territories
  • Government of Nunavut
  • The College of Family Physicians of Canada
  • Winnipeg Regional Health Authority
  • MB HealthCare Providers Network
  • Northern Regional Health Authority
  • Prairie Mountain Health Region
  • Southern Health
  • General Medical Council UK
  • Health Professions Council of South Africa
  • Medical Council of New Zealand
  • Interlake-Eastern Regional Health Authority

Submit your signed consent and payment to:

College of Physicians & Surgeons of Manitoba
1000 – 1661 Portage Avenue
Winnipeg MB R3J 3T7
Email: copc@cpsm.mb.ca
Fax: 204 774 0750
Phone: 204 774 4344

COPC Consent Form

COPC Sample

Authorization for Payment Form

FAX Information