Perinatal Substance Use Expert Panel Application Form

The  Champlain Maternal Newborn Regional Program (CMNRP) Perinatal Substance Use Expert Panel will provide guidance and expert opinion, informed by evidence-based literature and experience, about one of the most pressing maternal-newborn care priorities requiring attention within the region.

Specifically, we are soliciting applications from health and social service providers, and parents with lived experience in the Champlain and South East LHINs.

For more information please contact Christina Cantin ccantin@cmnrp.ca or 613-737-2660 x 3246.

Thank you for your application. Applicants will be contacted.

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* 1. First and Last Name

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* 2. Phone Number

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* 3. Email

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* 4. I am a family representative

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* 5. I am a health care provider / social service provider / community member

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* 6. Why is this expert panel of interest to you?

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* 7. Please share a brief description of your personal or professional experience related to substance use.

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* 8. Is there anything else you would like us to know about you?

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* 9. How did you hear about this expression of interest?

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