By completing this Self-Learning Activity for the Changing the Way We Work (CTWWW) Community of Practice for Ontario Family Physicians, you are confirming that you have completed this activity.

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1. Attestation: I confirm that I have completed the CTWWW CoP self-learning activity (video and resources). (If completing multiple session dates, please enter all that apply below
ENTER DATE AS Month-Day-Year i.e. December 10, 2021) (Required.)

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2. Please confirm the number of sessions you have completed. (Reminder: 1 session = 1.25 MainPro credits) (Required.)

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3. Please enter your first and last name exactly as you would like for the Attendance Certificate (do not include titles such as Dr.) (Required.)

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5. Provide your CFPC # to have your credits entered directly. Note: your CFPC is 6-digits and starts with a '6' or '7'

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6. My overall experience with this session was positive. Please select one.

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7. What ideas/approaches did you hear today that you believe you can test or implement in your practice?

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8. Did you perceive any degree of bias in any part of the program? (Required.)

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9. After reviewing this CTWWW session material (video and resources ), I have a question (s) regarding the content that needs clarifying. (Required.)

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10. To help us continue to plan to meet your needs, please indicate your practice model

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11. Ontario Health Region

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12. Please indicate if you self-identify as any of the following (select all that apply):

Thank you for completing session(s) of the CTWWW CoP self-learning program.
The Certificates of Attendance for completing these sessions are issued by email once per month, at the beginning of the month. If you selected to have your Mainpro+ credits directly entered, these will show up in your account holding area within 4-6 weeks after you receive the Certificate.

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