FPSC Mentorship Claim Form

  • FPSC Provincial Mentorship Claim Form

    The purpose of this form is for participants to claim their mentorship sessional hours. 

  • FPSC’s Provincial Mentorship Program is designed to provide mentorship to family physicians at the individual, local, and provincial levels. It builds on existing mentorship initiatives in the province and aims to expand access to mentorship opportunities provincially.


    The purpose of this form is for participants to claim their mentorship sessional hours. The form should be submitted by the mentor and mentee after completion of the program, or within three months of the mentorship sessions, whichever comes sooner. Mentors and mentees may access up to 5 hours (2 hours for mentees in the locum stream) of paid one-on-one mentorship for each service stream. Participants must track their mentorship dates and hours for submission.


    Please be aware that claims submitted three months after the service date will be subject to further review per FPSC policy and may not be approved. As such, we encourage participants to submit their claims within this time frame. Payments will be remitted to the bank account linked on their Doctors of BC profiles to receive sessional payments within 3-6 weeks after claim form submission.


    If you have any questions about your sessional claims, please contact us at fpscmentoring@doctorsofbc.ca. 

  • Are you submitting a claim as a mentor or a mentee?*

  • Claiming Mentorship Hours

    For mentors

  • To claim for sessional payment, please indicate the date, number of hours, and your mentee's name, clinic/facility name and mentorship stream.

    If you are a mentor for multiple mentees and streams, you may submit a single claim. 

    Mentors and mentees may access up to 5 hours (2 hours for mentees in the locum stream) of paid one-on-one mentorship for each stream.

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  • Claiming Mentorship Hours

    For mentees

  • To claim for sessional payment, please indicate the date, number of hours and your mentor's name.

    Mentors and mentees may access up to 5 hours (2 hours for mentees in the locum stream) of paid one-on-one mentorship.

    Please note that if you are participating as a mentee in more than one stream, please submit one claim form per stream.

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  • Participants may only access up to 5 hrs of mentorship hours per service stream.

  • Please select any that may apply to this submission:*

  • Long-term Care Mentorship Post Program Evaluation

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, we’d like to ask you to rate your agreement with the following statements.  These questions were included in your application for the program.
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  • Pregnancy and Newborn Care Mentorship Post Program Evaluation

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, we’d like to ask you to rate your agreement with the following statements.  These questions were included in your application for the program.
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  • Longitudinal Family Practice Mentorship Post Program Evaluation

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, we’d like to ask you to rate your agreement with the following statements.  These questions were included in your application for the program.
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  • Longitudinal Family Practice Locum Mentorship Post Program Evaluation

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, we’d like to ask you to rate your agreement with the following statements.  These questions were included in your application for the program.
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  • Inpatient Care Mentorship Post Program Evaluation

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, we’d like to ask you to rate your agreement with the following statements.  These questions were included in your application for the program.
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  • Mentee - Program Effectiveness

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, please answer the following questions:
  • Was it easy to sign up to be a mentee?*
  • Did the mentor address the specific topics in your area of practice(s) that you sought support in?*
  • Do you plan to continue working in the area of practice of your mentorship?*
  • Please select which area(s) you plan to continue working in:*
  • Please rate your agreement with the following statement: "I received personalized mentorship and skill-building opportunities through my participation in the program."*
  • Would you consider referring others to the program?*

  • Mentor first claim - Program Effectiveness

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, please answer the following questions:
  • Was it easy to sign up to be a mentor?*
  • Would you consider referring other physicians to the program?*

  • Mentor final claim - Program Effectiveness

    To help us evaluate the effectiveness of the FPSC Provincial Mentorship Program, please answer the following questions:
  • Please share with us why this is your final claim submission as a mentor in the FPSC Provincial Mentorship Program:*
  • Please rate your agreement with the following statement: "I enjoyed my experience as a mentor."*
  • Please select which area(s) you plan to continue working in:*
  • Would you consider referring others to the program?*

  • Mentorship Claim Form Confirmation

  • Please respond to the following statements to confirm your claim form submission:*
  • Should be Empty: