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* 1. In what professional capacity do you provide care, services, or support to families experiencing pregnancy or infant loss?  For example, nurse, physician, social worker, chaplain, etc.

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* 2. What is the name of your workplace or organization?  Please include where you are located.

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* 3. In which area is your practice or work primarily located?  For example, Emergency Department, L&D, Community Health Centre, Family Health Team, Mental Health, etc. 

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* 4. In your opinion, what works well about PAIL's Community of Practice?

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* 5. In your opinion, what could be improved in future community of practice events?

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* 6. Is there anything specific you would like included in future community of practice events?

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* 7. Are you willing to have your email shared with other Community of Practice participants?  If yes, please enter your email address into the comment box below. 

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