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Concerned Ontario Doctors Membership Application

Mission Statement

Concerned Ontario Doctors is a grassroots not-for-profit organization of physicians across Ontario advocating for a patient-centred, sustainable, accessible and quality healthcare system. We stand united in our belief that unilateral actions by any government will undermine our ability to deliver timely and quality patient care.

Annual membership for Ontario physicians is $250. Any additional donations are appreciated.
There is no annual membership fee for medical residents and medical students, but we kindly ask that you make a donation to help with our advocacy efforts.

Fields in bold are required.

Personal Information

Name Prefix:
First Name:
Middle Name:
Last Name:
CPSO #:      (Optional for students)
Do you practice in Ontario:
Are you... :
Name of University:
Year of Program:
Medical Specialty:

Primary Office Location

Address 1:
Address 2:
Postal Code:
Fax Number:

Home Location

Address 1:
Address 2:
Postal Code:

Contact Methods

Personal Email:

Become A Member

Leave a comment: (optional)

Credit Card Information

Name on Card:
Credit Card Number:
Month: / Year: