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Forms

Physician Forms

New Licensure Applications:

Full Licensure for both family and specialties
Must apply at www.physiciansapply.ca. Once application is received an application package will be sent to obtain the additional documents that are required to complete registration and licensing.

Post Graduate
Post Grad Application and Checklist
Prescription Privilege Undertaking Form

Medical Student
Medical Student Application

International Medical Graduate
Yukon is not currently accepting applications from IMGs. You must meet the requirements for full licensure.

Yukon Hospital Privileges
Application Process for Residents, Medical Students and Observers to Obtain Yukon Hospital Privileges

Licensure Renewal:

Medical Professional Corporation – Due December 1st
Professional Corporation - Licence Renewal Application Form

Medical Practitioner - Due March 1st
Medical Practitioner Licence Renewal Application Form
Medical Practitioner Strike from Registrar Form

MAID Forms:

Patient Request for Medical Assistance in Dying (MAID)

Most Responsible Practitioner Record for Medical Assistance in Dying (MAID) - Eligibility Assessment

Most Responsible Practitioner Record for Medical Assistance in Dying (MAID) - Patient Safeguards and Administration

Secondary Assessor Record for Medical Assistance in Dying (MAID)

Other Forms:

Fee Schedule

Payment information

Cannabis for Medical Purposes - Patient Medical Document

Methadone Authorization Application Form

Request for Certificate of Standing (or Certificate of Professional Conduct) Form

Supervised Practice Assessment Form - Limited Family Practice Licensed Physicians