Communication Preferences

How would you like the CCA to communicate with you?

*Preferred Email

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*Preferred Phone

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Preferred Fax

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Preferred Address

*Address Line 1

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Address Line 2

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*City

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*Province Select Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Yukon Nunavut

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*Postal Code

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*Country Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Aland Islands Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Democratic Republic Of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Cote D'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Republic of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Federated States of Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Reunion St. Barthelemy St. Helena Ascension and Tristan Da Cunha St. Kitts And Nevis St. Lucia St. Martin St. Pierre And Miquelon St. Vincent And The Grenedines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States US Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands British Virgin Islands U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

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General Information

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).

CCA Member ID

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Middle Name

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Former Last Name

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Nick Name

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Date of Birth

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Gender Select Male Female

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Education Information

Please enter your education information below.

Undergraduate School

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Undergraduate Degree

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Postgraduate Degree

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Chiropractic College Attended

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Date of Graduation

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Current Licence

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Date of First Licence

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Practice Start Year

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Previously Practised in Canada Yes No

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Previously Practised Abroad Yes No

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Clinic 1 Info

Please enter up-to-date Clinic 1 information.

Clinic Address

Clinic 2 Info

Please enter up-to-date Clinic 2 information.

Clinic Address