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Brockville General Hospital - Application for Clinical Training

Brockville General Hospital requires the BGH Electives Application Form (Application for Clinical Training) be completed by all Medical trainees at least 4 weeks before their clinical experience commences.  All application forms are to be accompanied with a recent photo and proof of immunization (Note: proof of TB test within the past year is needed).  The Brockville General Hospital requires that each student meets all of the requirements as summarized here - Communicable Disease Screening Requirements.

Badge Deposit Process - Learners are required to send a deposit form directly to the BGH Business Office and will only be charged a $20 fee if their BGH badge is not returned within 7 days after the end of their rotation.

Failure to submit a completed Electives Application form along with all supporting documentation at least 4 weeks in advance of the proposed rotation start date will result in Brockville General Hospital cancelling your rotation.

Please return completed Electives Application Form and all supporting documentation by email to or by fax 613-345-8305. If you have any questions regarding the form please contact:

Katie Stone
Education Assistant
Telephone:  613-345-5649 ext 51499
Fax:  613-345-8305