Request for Attachment to a GP - Physician Health Program

Before you make a request

The Physician Health Program (PHP) believes that all physicians should establish a long-term, trusting relationship with a primary care provider (PCP).

PCPs can be in short supply. Given the constraints, our program policies are as follows:

Please make a request for attachment only when you are ready to see it through to an actual appointment with a PCP.
- If we succeed in matching you to a PCP, but you do not book an appointment within three weeks of receiving the match, your relationship is not established, and the match may no longer be valid.
- Should you miss this deadline, we will ask you to wait six months before offering the matching service to you again.
Please note that this service is available to physicians and trainees only, and not to their family members.
- Once you have established a relationship with your PCP, you may ask about the possibility of accepting your family members as patients; however, the PHP cannot liaise this relationship and your PCP may decline this request.
Be advised that, in certain cases, the PHP partners with local Divisions of Family Practice who perform the task of matching PCPs to our physician-clients.
- Only your gender, year of birth and any potential reasons for urgency are transmitted to the partner organization. Your name and other identifying information are not transmitted.

To make a request for attachment to a PCP:

Complete the form below.
A confirmation email will be sent notifying you that your request has been received.
Once a suitable PCP match has been found, another email will be sent informing you of the contact details and booking instructions for your new PCP.
Contact your new PCP within 3 weeks to book your first appointment; please note that your appointment need not occur within 3 weeks.
- Your relationship with the PCP is not confirmed until you book a first appointment.
Confirm with us that you have booked an appointment, and that your relationship is established.

Information required:

First Name*

Last Name*

Email*

Best phone number to reach you where a text message can be left (mobile)*

Date of Birth*

Gender

Female Male Other

Do you have a BC Health card (BC Services Card)?*

Yes No

In which geographic Division of BC would your PCP ideally be located?*

Desired intersection/Neighbourhood. Please provide up to two alternate locations in case your first choice is not available.

Are you a practicing physician, resident or medical student?*

Are you willing to receive primary care from a Nurse Practitioner?

Yes No

How did you hear about our services?

What are your reason(s) for reaching out to the Physician Health Program for a PCP attachment?

Additional comments incl. any medical information which you wish to share or if you would like to be connected with a staff member to access any other services:

How we can help.

Before you make a request

To make a request for attachment to a PCP:

Information required: