Content saved successfully...

PROVINCIAL ADMINISTRATION PORTAL ONTARIO

Provincial Administration Portal > Add New Member

Add New Member

CCA member profiles help chiropractors put their best face forward. Here, chiropractors can introduce their practice to the CCA community, clients, and prospective clients. All content in the member profile should be as complete as possible.

Please note that if a primary practice is run from a home address location, the home address information should be listed on both the contact information tab and the clinic information tab (under the Clinic 1 address).

General Information

Fee Category *

Title

First Name *

Middle Name

Last Name *

Preferred Language *

Preferred Mailing Address

Address Line 1 *

Address Line 2

City *

Province *

Postal Code *

Country *

Preferred Phone *

Preferred Fax

Preferred Email *

License No. *

CCPA Number

Graduation Date. *

I am currently in good standing with my Provincial Association? Yes No

In which province will you be practising? *

I consent to receive newsletters from the CCA via email. I understand I can unsubscribe any time.

I consent to receive messages from the CCA via SMS.