Health Provider Registry for BC’s Emergency Response

Please refer to the FAQ’s when completing this form.
If you encounter problems completing/submitting this form, please email

Your personal information is being collected in compliance with BC privacy legislation under section 26(c) and (e) of the Freedom of Information and Protection of Privacy Act. Your information will be retained for five years and be shared with the Ministry of Health, Health Match BC and health authorities, to support B.C.’s health emergency response.

If you have any questions about our collection or use of personal information, please email your inquiries to


I am a registrant in good standing.
I confirm that I am a registrant/member in good standing with my regulatory, oversight or credentialing body (for example, BC College of Nursing Professionals, BC Care Aide and Community Health Worker Registry, Canadian Society of Respiratory Therapists).

Registrant Speciality

If you are currently employed by a Health Authority, please indicate which Health Authority:
Please indicate your preferred Health Authority/Authorities for deployment:
In the event of deployment, identify all of the placement options you would be prepared to support:
Have you received immunization training in the past five years?
I certify that I am the person named in this form.
By checking the box, I certify that I am the person named in this form and all information provided is true and complete to the best of my knowledge.