New Clinical CPSO/CPD Sign-up


Clinic Practise (NOTE: Clinical CPSO CPD Membership requires practising a minimum of 51% Psychotherapy, Mental Health and/or Addictions)

Clinical Practice

(i.e., BSc, MD, MDPAC(C), etc.)

How did you hear about MDPAC? (select all that apply)
 Booth at CPA/Primary Care Conference  
 Social Media  


Therapy Provided
 Accellerated Experiential Dynamic Psychotherapy  
 Acceptance and Commitment Therapy  
 Clinical Hypnotherapy  
 Cognitive Behavioural Therapy  
 Cognitive Meditation Therapy  
 Compulsive Sexual Behaviours  
 Couples Therapy  
 Developmental Needs Meeting Strategies  
 Eye Movement Desensitization and Reprocessing Therapy  
 General Psychotherapy  
 Gestalt Therapy  
 Internal Family Systems  
 Interpersonal Psychotherapy  
 Mindfulness Based Therapies  
 Neuro-Linguistic Programming  
 Psychoanalytic Psychotherapy  
 Satir Therapy  
 Schema Focused  
 Sex Therapy  
 Sexual Orientation and Gender Identity  
 Transaction Analysis  

Special Interest

Special Interests
 Anxiety Disorder  
 Borderline Personality Disorder  
 Chronic Illness  
 Dissociative Disorders  
 Eating Disorders  
 Mood Disorders  
 Palliative Care  
 Personality Disorders  
 Stress Management  


Please check off additional languages in which you provide psychotherapy service (check all that apply)


Are you licensed to practice medicine in Canada
 Y    N

Please indicate the provinces/territories where you hold a license to practice medicine

CPD and Educational Credit Reporting

If you belong to the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada you can use them to report your Continuing Professional Development (CPD) or educational credits to the College of Physicians and Surgeons – only one pathway is required.

I belong to the Royal College of Physicians and Surgeons of Canada (RCPSC)
 Y    N

I plan to report my CPD to the CPSO through the RCPSC
 Y    N

I belong to the College of Family Physicians of Canada (CFPC)
 Y    N

I plan to report my CPD to the CPSO through the CFPC
 Y    N

If you do not belong to the RCPSC or the CFPC, do you wish to use the MDPAC as your Pathway to report your educational credits to the CPSO?
 Y    N

CPSO Consent
 I give consent for the MDPAC to give the CPSO any information about my CPD that the CPSO requires, to show them that I have fulfilled the necessary requirements. I understand that this consent will remain in effect unless or until I withdraw this consent in writing. I also understand that I am required to be a Clinical CPSO/CPD, Certificant or Mentor member of the MDPAC in good standing for every year of the cycle for which a report is made. I understand I need to fulfill the requirements as determined by the MDPAC to complete the 3 year cycle.  

Privacy Information

I grant MDPAC permission to sell my data for marketing purposes
 Y    N

Show my email on the public find a physician who practices psychotherapy directory
 Y    N

In an effort to be environmentally conscious, MDPAC would like you to consider receiving your MDPAC Journal electronically.
 Yes, please send me MDPAC Journal electronically.  

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