Application for Consent to Transfer a Licence

The Licence Transfer Application must be submitted when requesting the Director's approval regarding the transfer of a centre. This application must be signed by the current licensee and the proposed transferee. No transfer of ownership of a licence can take place without the prior written approval of the Director of Integrated Community Health Services Centres.

Download the Application for Consent to Transfer a Licence form

ICHSC Physician Affiliation Authorization

When the Integrated Community Health Services Centres (ICHSC) Program receives a request to affiliate a physician to a centre, the program will confirm the physician's qualifications to provide the requested services prior to processing the affiliation. This may require the licensee and/or the physician to provide additional information for review (for example, a letter acknowledging their qualifications from the College of Physicians and Surgeons of Ontario (CPSO)). The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.

Download the Physician Affiliation Authorization and Declaration of Professional Standing for Integrated Community Health Services Centres (ICHSC) form

Quality Advisor Acknowledgement

Licensees are required to appoint and maintain a quality assurance advisor to oversee the quality assurance program at the community surgical and diagnostic centre and provides quality-related advice to the Licensee. The ICHSC Program must be notified of a change in quality assurance advisor through the submission of the Quality Assurance Advisor form which must be signed by both the centre’s quality assurance advisor and the licensee.

Download the Quality Assurance Advisor form


The policy for relocations is included in the Fixed Site Relocation application  and is found starting on page 7.

There are different criteria if the move is:

  • less than 5 kilometers
  • more than 5 kilometers but in the same catchment zone
  • more than 5 kilometers and outside of the current catchment zone

Download the Fixed Site Relocation application


The Application for the Expansion of Fixed Facilities form allows centres to request new services to be added to their existing licence.

Only the current licensee (either a person or corporation) is eligible to submit an expansion application. An application to expand a licence will be cancelled if there is a pending application to transfer ownership of the centre.

To receive a copy of this form please email the program area at