Change of Address Notification
This form is provided for members to notify the College of any change in address
The College’s register must contain your
current mailing address, email address,
and your primary practice address.
And we have made it easier for you to
do that - you can now change your
address and update your information
in the Members’ section of our website
at www.cpso.on.ca
You can also send us the change of
address form below. Please mail, fax, or
email it to the College.
Your mailing address is the address
you would prefer the College use to
communicate with you and may be
different from your practice address. It
is NOT available to the public, unless
you decide to use your primary practice
address as your mailing address. Your
primary practice address is available to
the public.
tice address, you must notify the College
in writing within 30 days of the change.
If not in practice, you may check the
“not in practice” but current mailing
address and email address must always
be provided.
Membership Services
College of Physicians and Surgeons
of Ontario
80 College Street
Toronto, ON, M5G 2E2
Email: [email protected]
Fax: (416) 967-2643
The College also uses your email address
for some communications. Your email
address is NOT available to the public.
Please mail, email or fax
this form to:
If you change your mailing, email or prac-
Updated address Information
(please print legibly)
CPSO Registration Number ___ ___ ___ ___ ___ ___
Surname
________________________________________________________________________________________________________________
Given Names
________________________________________________________________________________________________________________
Name of your Medicine Professional Corporation (if applicable)
________________________________________________________________________________________________________________
primary practice address:
Not in practice q
mailing address:
Same as primary practice address q
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Postal code
___________________________________________________
Postal code
___________________________________________________
Phone number
___________________________________________________
Phone number
___________________________________________________
Fax number
___________________________________________________
Fax number
___________________________________________________
q Check here Y