***OBC Membership Application Submission Site

Which address would you like your mail sent to?

Have you ever been convicted of a criminal offence? (Parking and minor traffic offences only punishable by fine may be excluded).

Please provide your name when the offence was committed and nature of the offence.

Please provide the date of the conviction and sentence (e.g. term of imprisonment/fine/probation etc.)

At which school(s) did you study Osteopathy? Please include the name of school(s), city and country.

Full Name of Osteopathic Diploma or Osteopathic Degree

Number of Years of Study (e.g. 4 or 5)

Full or Part-time Program

Designation (e.g. D.O.M.P., M. Ost., M.OMSc, etc)

START DATE

GRADUATION DATE

Was there a research (study/thesis/project) component?

Please provide information on the research study/thesis:

What education/professional health qualifications did you have upon entry to your full or part-time osteopathic studies? (E.g. Prior health care diploma, Bachelor of Science, etc.) If you completed a four-year full-time or five-year full-time osteopathic program and do not have a prior health care qualification, please answer N/A.

Please list attainment dates for the above list (mm/yyyy).

How many years of experience did you have in your previous health profession(s) if applicable?

Upload your Osteopathic Diploma here

Upload your prior HealthCare Degree/Diploma here (mandatory when part-time program)

When did you first practise osteopathy? (mm/yyyy)

In which countries have you practised, and when?

Describe the type and scope of your practise referred to above.

Are you currently practising osteopathy?

Please explain why you are not practising osteopathy and provide details:

Was the allegation of negligence found to have been proved?

Please give the details of any judgement of the negligence which was given against you.

Was the allegation of misconduct found to have been proved?

Please give the details of any judgement for the misconduct which was given against you.

Are you currently protected by at least a 5 million dollar policy of osteopathic professional liability insurance for British Columbia?

If no, for what amount?

During which periods have you held such insurance in the past?

Have you ever been required to pay an increased premium for such insurance?

If you know why you were required to pay an increased premium, or why you were quoted insurance on loaded terms, or why you have been refused insurance, please give details:

Have you ever been refused such insurance?

Are you a member of any provincial, national or international osteopathic organization(s)?

Please name the osteopathic organization(s) and include the dates you were a member of the osteopathic organization(s).

Are you a member of any other professional healthcare organization(s)?

Please name the healthcare organization(s) and include the dates you were a member.

Have you been on a register maintained by a professional regulatory body?

Please list name(s) of the regulatory body with the dates when you were registered.

Have you ever been refused registration as an osteopath/osteopathic practitioner by any professional regulatory body in any country or in any Canadian province?

Please name the professional regulatory body and say the reasons given for refusal.

Have you ever been struck off any register by a professional regulatory body?

Please give details of the register and the date.

Reason for being struck off by professional regulatory body.

Have you ever been suspended by a professional regulatory body from providing osteopathic or other professional services?

Please give details of the professional regulatory body and the dates during which the suspension was effective.

The reason why you were suspended from a professional regulatory body.

Have there ever been any other disciplinary findings made against you by a professional regulatory body?

Please give details of any other disciplinary findings made against you by a professional regulatory body.

Are there any unresolved complaints against you that have been made to a professional regulatory body?

Please name the professional regulatory body(ies) and date(s).

Nature of each unresolved complaint.

Upload Proof of Membership in an osteopathic National Registry if applicable

Upload your most recent membership certificate/proof from any professional osteopathic organization you currently or previously belonged to if applicable.

1. I consent to OBC forwarding my required contact and membership information to insurance companies for the purpose of procuring or maintaining osteopathic coverage for OBC members.

2. As a member, you will receive regular email updates from OBC. Communications may include e-newsletters, membership and association information and details on upcoming conferences, training and events organized by OBC and/or its partner organizations. Please indicate below if you give permission for your email address to be added to the OBC communication list.

3. I consent to the OsteopathyBC/SPMPO Board contacting me via the preferred email I have supplied for official notification of legally required membership-related information such as election notifications, Bylaw amendments, and Annual General Meeting notices.

4. I consent to being contacted by email for the purpose of research by osteopathic researchers and osteopathic student researchers.

5. I consent to have my name and contact details listed on the OBC website.

6. I consent to have my name included in OBC materials created for members only.

Thank you for your Application