Report Misrepresentation

Report a physician claiming to be a dermatologist or who is providing unlicenced dermatologic care

False, misleading or deceptive claims (by inclusion or omission), advertisements and/or communications by a physician about his or her professional qualifications whether directly or indirectly to the public are not permitted and can be submitted to a Provincial College of Physicians and Surgeons for investigation.

To report someone misrepresenting himself or herself as a dermatologist, please complete and submit the form below. The CDA will advise the appropriate College of the reported incident. At all times, your personal information will be kept confidential.

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Physician of Concern

Full Name (Required)

First Name *

Last name *

License Number

Certifications

Address (Required)

Full Address

Province *

Details

Date of Incident *

Description of incident to be investigated *

Description of any efforts made to resolve the incident

If the following is relevant, please complete.

Clinic/Practice Name

Is this a private practice or a group practice?

Website

Social Media App and Handle

Supporting Documents and Materials

File Upload

Max. file size: 6 MB, Max. files: 4.

Provide all documents and materials (e.g. copy of letterhead, copy of advertising, photo of signage, etc.) to validate the incident.

Maximum size 6 MB

Your Contact Information (for CDA purposes only)

Full Name (Required)

First Name *

Surname *

E-mail *

Please Confirm

I acknowledge I may be asked to provide further details and/or evidence relating to this incident.

I certify that the above statements are true and correct to the best of my knowledge.