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Veterinary Practice
Accreditation
Temporary Facilities
Ophthalmic Screening Program
In This Section
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Cardiac Screening Program
Congenital Deafness Screening Program
Microchip Clinic
Ophthalmic Screening Program
Rabies Program
Facility Accreditation Emblem
2
Facility Director
2
Accreditation Standards
2
Accreditation Process
2
Prepare for Inspection
2
Accreditation Committee
2
Sample Documents
2
Temporary Facilities
Cardiac Screening Program
Congenital Deafness Screening Program
Microchip Clinic
Ophthalmic Screening Program
Rabies Program
2
Ophthalmic Screening Program
Sponsoring Veterinarian Information
First Name
*
Last Name
*
Licence Number
*
Email
*
Participating Veterinarian(s)
The procedures relating to this program will be performed by
Myself, as a diplomate of the American College of Veterinary Internal Medicine in Ophthalmology
Another veterinarian who is a diplomate of the American College of Veterinary Ophthalmologists, and has obtained a short-term licence to practice in Ontario
Participant Name #1
*
Participant Name #2
Participant Name #3
Participant Name #4
Participant Name #5
Participant Name #6
Participant Name #7
Participant Name #8
Participant Name #9
Participant Name #10
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Location of Ophthalmic Screening Program
Name of Facility or Building
*
Street Address
*
City
*
Postal Code
*
Is this an accredited facility?
*
Yes
No
Program Date(s)
Start Date
*
End Date
Sponsoring Veterinarian Declaration
I, the sponsoring veterinarian, currently licensed with the College of Veterinarians of Ontario, hereby confirm that:
*
I am a licensed member of the College of Veterinarians of Ontario and agree to abide by the College’s Policy Statement on Ophthalmic Screening Programs and all other relevant legislation.
Signature
By checking this box, I confirm that I am the licensed member submitting this application. I confirm that the information entered on this form is true and correct. I understand that it is professional misconduct to submit false or misleading information to the College (as per Regulation 1093 ss 38.1)
*
Submit Application