Independent Practice Form test
PERSONAL CONTACT INFORMATION

Please enter your name and registration number
BASIC INDEPENDENT PRACTICE INFORMATION

Please answer the following questions about your Independent Practice (self-employment). If you don't have a business name or separate contact information, please enter your personal information below.
Address: *
Address:
City
State/Province
Zip/Postal
CONTACTS

Do you have other LPN associates who are hired under your Independent Practice (Self-employment)?
Additional Contacts:
INSURANCE

The Independent Practice Bylaw requires proof of additional liability insurance.
I have additional liability insurance. *
If no, please be advised additional liability insurance will be required by June 1, 2020.
Additional liability insurance can be obtained through our existing provider, Lloyd Sadd, or can be obtained through an outside broker of your choice.
If applicable, please upload a copy of your liability insurance.
Maximum upload size: 25MB
Policies/Procedures

The independent practice bylaw requires practitioners to adopt policies/procedures related to physician orders, record keeping, patient consents, infection control, and referrals.
I have policy/procedures for my independent practice *
PAYMENT INFORMATION

Please enter your credit card information to process your Independent Practice Registration.
Fee: $100.00
Click submit to complete your registration.