College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

1 of 1

Temporarily InactivePARENTAL LEAVE (RETURN TO WORK)

REGISTRATION STATUS CHANGES TO ACTIVE, PRACTISING

I hereby give notice that I will be returning to practice after parental leave as follows:

My first day of work will be (YYYY-MM-DD):

Note: Changes of status cannot be backdated. Please provide two weeks notice for status change.

I understand that my registration status will change from Temporarily Inactive – Parental Leave to Active, Practising for my first day of work. I will pay the balance of my annual licence renewal fee.

Registrant full name: CPSID:

Signature: Date:

Note: If you are currently a registered care advisor, you will need to reapply through the College upon your return to active practice.

Please return this form by:

Mail ATTN: Registration Department College of Physicians and Surgeons of BC 300–669 Howe Street Vancouver BC V6C 0B4

Fax Email Inquiries

604-733-3503 registration@cpsbc.ca 604-733-7758 ext. 2626

The information in this form is collected under the authority of the College Bylaws under the Health Professions Act, RSBC 1996, c.183. The information provided will be used for updating your registration status with the College. If you have any questions about the collection and use of this information, please contact the College at 300–669 Howe Street, Vancouver, BC, V6C 0B4 or by phone at 604-733-7758 or 1-800-461-3008 (toll free in BC).