• Fitness to Practice Disclosure Form

  • Fitness to Practice Reporting Form

  • Are you a current registrant of the College?*
  • Format: (000) 000-0000.
  • Do you know the name of the registrant?
  • Did you know?

    Anyone who believes that a medical radiation technologist (MRT), electroneurophysiology technologist (ENP) or medical diagnostic sonographer (DMS) has not provided care in a competent and professional manner can make a complaint to the Complaints Director of the College.

    Click here to read more.

  • Date of incident*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of initial impairment*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Summary of the Fitness to Practice Disclosure

  • Summary of the Fitness to Practice Concern

  • Is the issue temporary or permanent?*
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  • Currently practicing?*
  • Is your Supervisor/Manager/Employer aware of your fitness to practice issue?*
  • Date of submission*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: