Please fill in the form below and submit it,.
Date / Month / Year
Dear Dr Surname.
Further to our discussions we are pleased to offer you a position and the following Terms and Conditions:
- Your relationship with (name of clinic) shall be one of association in the practice of medicine and shall not be deemed to be an employer/employee or partnership relationship.
- This association shall commence on (add month/year). The term of this contract is (X) years. You will practice medicine in a style similar to the other-physician(s) in the Clinic.
- If an IMG (International Medical Graduate), (name of clinic) will be responsible for providing the required supervision and/or sponsorship specified by “The College of Physicians and Surgeons of (Enter name of Provincial College) allowing you to be licensed to practice.
- All patient charts will be maintained at (name of clinic) and shall remain the property of (name of clinic)
- You would be guaranteed a minimum of (X) hours of medical practice as a physician, on a weekly basis, at (name of clinic) some of which may be evenings and/or weekends.
- With regards to the administration of your practice, you will be provided with a turnkey operation. (name of clinic) will handle the booking of all appointments (according to your method of scheduling), administer the billing and collection of fees and provide all staff, services, equipment and facilities necessary for you to carry on the practice of medicine at (address of clinic)
- Your remuneration will be based on a (X/X) Split commencing from the start of your term at the clinic. You will receive X % of gross income and X % will be retained by (name of clinic) to cover all overhead cost outlined above.
- Gross income shall include all patient related income. (NO OVERHEAD IS TO BE PAID FOR HOUSE CALLS). All payments made directly to you should be endorsed and made payable to (name of clinic) and submitted to (name of clinic) within 3 business days.
- You will be paid on monthly basis. The payment will be made within 3 business days of (name of clinic) receiving payment from (Name of organization making payment)
- You will be personally responsible for expense related to CMPA fees (Canadian Medical Protective Association), memberships and dues for medical associations, colleges, societies etc., personal life and disability insurance, personal automobile expenses, books, periodicals and educational costs.
- All equipment, instruments, facilities, supplies and services provided by (name of clinic) shall remain the property of (name of clinic)
- Appropriate advance promotional notices will be published / advertised to announce your association with (name of clinic) and your name and credentials will be added to the letterhead, appointment slips, prescription pads etc. Appropriate signage will also be provided in the clinic to indicate your presence.
- You Shall not at any time within a period of twelve (12) months from the date of termination of work at (name of clinic), either individually or in partnership or in conjunction with any person or persons, firm, association, syndicate, company or corporation, as principal, agent, director, officer, employee, investor or in any other manner whatsoever directly or indirectly carryon, be engaged in, be interested in, or be concerned with or permit your name or any part thereof to be used or employed by any such person or persons, firm, association, syndicate, company or corporation , carrying on , engaged in , interested in or concerned with a business which is same or similar to the services provided by (name of clinic) including but not limited to the practice of medicine within five (5) kilometers (address of clinic)
We trust that this letter is a clear understanding of your association with (name of clinic). We are very pleased that you are joining the Clinic and we will look forward to a long and mutually rewarding relationship.
Name of owner/clinic
I have read the above letter of understanding and hereby agree to the terms and conditions contained herein.
Name (Printed): _____________________________