Payment Details Forms: Office Base Preceptors

These payment detail forms are for those eligible office based preceptors who have been contacted by the OIME. For more information regarding eligibility please review the Payment Funding Fact Sheet.

Forms can be scanned and emailed to

I do not have a Medicine Professional Corporation or Registered Company:
     Payment Details Form – T4A Payments
     Small Trader Certificate
***Please remember to include a cheque marked “VOID” along with your payment details.

I have a registered Medicine Professional Corporation, Partnership or Business:
     Payment Details Form – MPC/Partnership/Business
     Small Trader Certificate
*** If you do not have a registered HST #, please remember to complete the “Small Trader Certificate”.