Physician Association Membership Form - Primary Care Network Durham

Physician Association Membership

The Association establishes a unified voice for primary care physicians with patients who receive care in Durham Region and allows members to elect or appoint individuals to represent them on Ontario Health Team (OHT) Governance Committees/Boards.

The purpose of the Association is to:

Co-design and implement integrated models of care with other Durham Ontario Health Team partners
Promote and ensure physician leadership and decision-making within the Durham Ontario Health Team
Create a forum for addressing clinical and policy issues relevant to their local community

Please provide your support for the creation of the Durham Ontario Health Team Physician Association by completing the form below.

Name (Last name, First name)

CPSO Number

Phone Number

Main Practice Address

Postal Code

Other

FHO/FHG Group Name (if applicable)

Approximate practice roster size (number ranging 0-5000)

Signature (Please type in your name)

By typing your name above, you agree to become a member of the inaugural Durham OHT Physician Association – the unified voice for family doctors in Durham Region. Signing this form does not create any binding legal obligations or commitments to the DOHT, it simply acknowledges your memebership to the Durham OHT Physician Association.

Together, we can advocate as one voice for appropriate support and funding for family practice in Durham Region, as it reshapes the delivery of health care for our patients.