Comox Valley Locum Coverage Request Form

Please complete this form to advertise your dates for locum coverage in the Comox Valley.
NOTE: Along with the physician name, only generic clinic email/phone information will be displayed on the website. Physician name/email/cell will be provided to locums directly via the Physicians Seeking Locums list sent out monthly.
Locum coverage dates:
Practice Description: 
i.e. Hospital Privileges / No Hospital Privileges, Maternity, On-call / no On-Call, Long-term Care, Mixture of Teleconf & In-Clinic appts, House visits, clinic orientation available, etc.
How many & which days worked.
Clinic description:
i.e. how many clinic rooms, MOA, RNs, and any other notable features about the clinic. 
Office Manager/Lead MOA & contact info:
Dedicated computer for physician use?
Is accommodation available ?
Additional Information/ Comments