PIPS Appointment of Responsible Veterinarian

Responsible Veterinarian Appointment Form
All veterinary practices are required to appoint a Responsible Veterinarian in accordance with the PIPS By-law approved at the 2026 AGM. To support a smooth transition and ensure compliance upon enactment, submission of this form is a mandatory requirement for all veterinary practices.

This form must be completed by the Responsible Veterinarian.

The appointed Responsible Veterinarian must:
- Hold an unrestricted licence and be registered as a General Veterinarian Member
- Be informed of all aspects of the veterinary practice
- Provide overall direction to ensure compliance with the Act, the By-laws, and all applicable Guidelines
- Serve as the primary decision-maker for operational matters
- Review, sign, and confirm the accuracy of all PIPS documents submitted to the MVMA
Please note:
- The Responsible Veterinarian does not assume responsibility for the conduct of other members within the practice
- All veterinarians and veterinary technologists remain individually accountable for their professional responsibilities
- If the Responsible Veterinarian resigns or becomes ineligible, a new appointment must be submitted within 30 days
Important: A veterinary practice that does not have a designated Responsible Veterinarian on file with the MVMA will not be considered compliant with the PIPS Bylaw once it comes into force.

The name of the Responsible Veterinarian for each practice will be published by the MVMA.

If you have questions before completing this form, please contact mvmainfo@mvma.ca
Practice Information
Practice Name
Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice E-mail
example@example.com
Practice Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Responsible Veterinarian Information
Name of Responsible Veterinarian

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
I confirm that as the appointed Responsible Veterinarian, I hold an unrestricted licence and I am registered as a General Veterinarian Member.
I confirm that as the appointed Responsible Veterinarian, I have no conditions, restrictions, or suspensions on my licence.
Role Acknowledgement
I acknowledge that, as the Responsible Veterinarian, I have overall authority for the veterinary practice.
I acknowledge that, as the Responsible Veterinarian I am informed of all aspects of the veterinary practice.
I acknowledge that, as the Responsible Veterinarian, I ensure compliance with the Act, the By-laws, and all applicable Guidelines.
I acknowledge that, as the Responsible Veterinarian, I am the primary decision-maker for operational matters.
I acknowledge that, as the Responsible Veterinarian, I am responsible for signing and confirming the accuracy of all PIPS documents submitted to the MVMA.
Signature
Signature
Date

MonthDayYear
Date
I understand this submission constitutes a formal designation of a Responsible Veterinarian with the MVMA.
Should be Empty:

Responsible Veterinarian Appointment Form

Practice Information

Responsible Veterinarian Information

Role Acknowledgement

Signature