Application: Authorization to use Title Specialist
Applicant name
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Email
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(Same email that is on file with the College of Physiotherapists of Alberta)
Registration number
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Specialty certification/designation
Physiotherapy Specialty Certification Board of Canada
Clinical Specialist (Cardiorespiratory)
Clinical Specialist (Musculoskeletal)
Clinical Specialist (Neurosciences)
Clinical Specialist (Oncology)
Clinical Specialist (Paediatrics)
Clinical Specialist (Pain Sciences)
Clinical Specialist (Seniors' Health)
Clinical Specialist (Sport Physiotherapy)
Clinical Specialist (Women's Health)
American Board of Physical Therapy Specialties
Cardiovascular & Pulmonary Specialist
Clinical Electrophysiology Speicalist
Geriatrics Specialist
Neurology Specialist
Orthopaedics Specialist
Pediatrics Specialist
Sports Specialist
Women's Health Specialist
Date certification awarded
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Month
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Day
Year
Date
Date certification expires
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Month
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Day
Year
Date
Certificate(s) of completion (PDF)
*
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Declaration statements
I declare that I hold the specialty certification indicated on this application form
*
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Yes
No
I understand that I must inform the College of Physiotherapists of Alberta immediately if I no longer hold the specialty certification.
*
Please Select
Yes
No
I understand that I can only use the title specialist while authorized by the College of Physiotherapists of Alberta.
*
Please Select
Yes
No
I certify and declare that the information provided in this application is true.
*
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Yes
No
Submission
Date
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Month
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Day
Year
Date
Signature
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