BPAO - Black Patients requesting Black Doctors -Sign up (Consent)
BPAO receives regular requests for Black primary care providers and for Black specialists. There is substantial international evidence at this point that Black patients have a higher likelihood of better outcomes with Black providers. CPSO does not collect race based data on physicians at this time so we are fulfilling this role in the interim. This is an act of solidarity with the Black community and we encourage you to let patients know your race.

Please note patients are also told to seek any other details about providers via the CPSO website.

If you consent to us providing community members with your race, first and last name, specialty and city of practice please fill out the required information below.

Once you have filled out this form you will be added to our database exclusive of BPAO members who have collectively provided consent.

Please indicate N/A where required

Should you have any questions please email us directly at info@bpao.org
First Name *
Last Name *
Phone Number
Business Phone Number *
Email *
City/Province *
Company/Organization Name *
Area of Expertise/ Practice *
Do you consent to BPAO providing your race to patients requesting a Black doctor or specialist? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy