Designated Medical Practitioner Handbook

Appendix XIV: DMP Acceptance of Appointment Form

DMP Acceptance of Appointment Form

I ______________________________________________________, of
(First Name, Initial, Surname)

------------------------------------------------------------------------------------
------------------------------------------------------------------------------------
------------------------------------------------------------------------------------
(Practice address)

Accept the offer of appointment as a practitioner performing Canadian immigration medical examinations. I acknowledge that I have read, understand and accept the instructions, directions and guidelines in the Handbook for Designated Medical Practitioners.

I understand that by accepting this appointment, I agree to undertake Canadian immigration medical examinations in the manner and format defined and directed in the handbook. The handbook sets out the rules and standards of my appointment. I also agree to adhere to and follow the policies, procedures and guidance outlined in the handbook and/or provided by CIC medical officials, and any changes to these policies and procedures as may be made by CIC from time to time.

_______________________________________     
(Print Name)

Date: _______/_____/_____
          YYYY    MM    DD

_______________________________________
(Signature)


The content below is offered in PDF format. For more information or to download the appropriate viewer, check the Help page.

Appendix XIV: DMP Acceptance of Appointment Form
>> PDF format, size: 149 KB

 

<< Contents | Previous | Next >>