1- General Information
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First name* |
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Last name* |
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Job title* |
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Division* |
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Organization* |
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Please indicate the type of organization in
which you work* |
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Other type of organization, please specify: |
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Which of the following best describes your status? |
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Practicing physician |
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Medical Resident |
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Other, please specify:
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What is your main area of practice? |
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Public health and preventive medicine (RCPSC) |
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Other specialty/subspecialty (RCPSC), please specify: |
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Family medicine - FP/GP (CFPC), |
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please specify primary practice focus if applicable |
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Other area, please specify: |
Are you a medical officer of health or associate medical officer of health? |
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Yes |
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No |
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City* |
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Province* |
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Country* |
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Email address* |
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Please re-enter your email address* |
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Phone number* |
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