Cease to Perform IVIT

The Inspection Program of the College of Naturopaths of Ontario inspects the premises where compounding for and the administration of IVIT are performed. It is necessary for the College to have an up-to-date record of all premises where these services are actively being offered.


This requires being informed by the designated Registrant of a premises where the compounding for or administration of IVIT are performed is either closing or the premises is ceasing to perform the procedures without closing the premises.

1. IVIT PREMISES INFORMATION

Please provide the following information about the IVIT premises where a procedure will no longer be performed.

Ontario
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2. DESIGNATED REGISTRANT INFORMATION

The designated Registrant is the naturopathic doctor who has been identified as the Registrant who is authorized to deliver and accept information on behalf of the premises. If there is only one naturopathic doctor authorized to perform IVIT procedures in the premises then that Registrant is the designated Registrant. In a premises where more than one naturopathic doctor is authorized to perform IVIT procedures in the premises one of the Registrants must be identified as the designated Registrant

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3. CHANGE IN PROCEDURES

Changes being made in procedures offered at this premises.*
Status of Change*


4. DECLARATIONS AND SIGNATURE

Please review the following declaration and the signature you are being asked to provide carefully.

Declaration of Truthfullness and Accuracy*

The information that I have provided is true and accurate to the best of my abilities. I understand that it may be considered an act of professional misconduct to make a false or misleading statement.

De-registration Declaration*

I understand that by no longer providing one or both of IVIT or compounding for the purposes of IVIT, this clinic no longer meets the requirements for the Inspection Program and will be de-registered as a premises under that program.

New Registration Required Declaration*

I understand that by asking that this premises be de-registered under the inspection program, should the administration of IVIT or compounding for the purposes of IVIT or both be re-considered for this location, the location will be required to be registered as a new premises under the inspection program and initial inspections conducted before providing any of the noted procedures.

Signature


By checking the box below, you are affixing a signature to this form and indicating that this form and the information contained herein was completed by you and is bound directly to you.



5. Submission Copy

Below is a check box to receive a copy of your submission. It is highly recommended that you check this box and enter your e-mail address for a second time. This will enable the on-line system to send you a copy of the information that you have provided to the College.


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