Request to Relinquish Standard of Practice for Intravenous Infusion Therapy

Request to Relinquish

Standard of Practice for Intravenous Infusion Therapy

By completing this form, a registrant of the College of Naturopaths of Ontario is making an application to relinquish having met the Standard of Practice for Intravenous Infusion Therapy (IVIT). Doing so means that the registrant will no longer be able to compound for or administer a substance listed in the table to the General Regulation.

At the end of this form, a link is provided to complete an Acknowledgement & Undertaking, a legally binding form. Both the application form and the A&U must be completed to relinquish the standard.

REGISTRANT INFORMATION

Please provide the following information about you.

First Name*

Please provide your given (first) name.

Middle Name

Please provide your middle name if you have one and it appears on your application for registration

Last Name*

Please provide your family (last) name.

Registration Number*

PRACTICE INFORMATION

Please provide the following information about your practice.

Please select the statement that meets your current situation.*

I am still practising IVIT but will cease on the date noted below.

I am no longer practising IVIT having ceased on the date noted below.

I have not practised IVIT since having met the Standard of Practice on the date provided below.

Please enter the date on which you will cease practising IVIT.*

Please enter the date on which you ceased practising IVIT.*

Please enter the date on which you met the Standard of Practice for IVIT.*

PRACTICE LOCATIONS

Number of Locations*

Please indicate the number of locations in which you are practising IVIT. If you are practising in more than 3 locations, please provide the relevant details for any of the locations after the first 3 in an email to registration@collegeofnaturopaths.on.ca.

Practice Location 1

Practice Name*

Practice Street Address*

City of Location 1*

Postal Code for Location 1*

Telephone for Location 1*

Phone

Email Address for Location 1*

Practice Location 2

Practice Name*

Street Address*

City of Location 2*

Postal Code for Location 2*

Telephone for Location 2*

Phone

Email Address for Location 2*

Practice Location 3

Practice Name*

Street Address*

City of Location 3*

Postal Code for Location 3*

Telephone for Location 3*

Phone

Email Address for Location 3*

DECLARATION AND SIGNATURE

Please review the following declaration carefully and provide your signature.

Declaration*

I hereby request to relinquish the Standard of Practice for Intravenous Infusion Therapy (IVIT). I understand that:

Relinquishing one’s Standard of Practice for IVITis not a temporary hold.
If I wish to resume the practice of IVIT after the Standard of Practice has been relinquished, I will be required to successfully complete a Council approved course in IVIT and the College’s IVIT examination prior to doing so.
My request is not effective until the College receives my completed Acknowledgment and Undertaking and confirms in writing that the Standard of Practice for IVIT has been removed from my certificate of registration.

If for any reason you cannot agree to the terms set out, please contact the Registration Team at registration@collegeofnaturopaths.on.ca to discuss your questions or concerns before you submit the form.

I agree

I do not agree

Signature

By checking the box below, I am hereby affixing my digital signature to this form and indicating that this form and the information contained herein is bound directly to me.

If for any reason you cannot affix your digital signature, please contact the Registration Team at registration@collegeofnaturopaths.on.ca to discuss your questions or concerns.

I voluntarily sign this form and affix my digital signature.

VERIFICATION OF IDENTITY

The following information is required as protection for you. It ensures that the College can be sure that the person completing this form is in fact the person whose name appears on it.

If you are unsure of this information, do not guess. Please log in to the User Portal from the College’s website and view your profile to obtain the corresponding information.

In the event that any of the identification information is not accurate, the form will be rejected by the College.

Date of Birth*

Please enter your date of birth in the day, month, year format. For example, 1 January 2001

Home Address Postal Code*

Please enter the postal code of your home address that is on file with the College. If you are unsure the postal code you have provided, please log into the User Portal on the College's website and check your profile.

Name of Naturopathic Educational Program*

Please enter the name of the naturopathic educational program from which you graduated. Individuals who have completed the Prior Learning Assessment and Recognition Program should enter PLAR.

Date of Graduation*

Please enter your date of graduation from the above named naturopathic education program using the day, month, year format, for example 30 May 2023. Individuals who have completed the Prior Learning Assessment and Recognition Program should enter the date they completed the PLAR Program.

ACKNOWLEDGEMENT & UNDERTAKING

In order to complete the process of relinquishing the Standard of Practice for IVIT, please proceed to complete the Acknowledgement & Undertaking which is a separate document.

COPY OF SUBMISSION

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

Send me a copy of my responses

Privacy Notice|Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.