Registration for Peer Connect Small Group with Drs. Joan Chan and Samantha Lavitt (open group)

Thank you for your interest in joining a Peer Connect small group. Please complete the registration form below to join a small group facilitated by Drs. Joan Chan and Samantha Lavitt. This group will meet on the following dates (Wednesdays) from 9:00-10:30am via Zoom.

April 2, 2025
May 7, 2025
June 4, 2025
July 2, 2025
August 6, 2025
September 3, 2025
October 1, 2025
November 5, 2025
December 3, 2025
January 7, 2025
February 4, 2025
March 4, 2025

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* 1. I commit to attending and participating in the group discussion dates listed above.

I agree.

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* 2. Please provide the following information:

First Name:

Last Name:

Email:

CFPC Number (for Mainpro+ credits):

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* 3. Please share topics/areas of interest you are hoping to focus on during these small group discussions.

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* 4. What challenges/barriers are you hoping these small group discussions can help you with?

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* 5. Identify your practice region:

Central Region 

Toronto Region

North East Region

North West Region

East Region

West Region

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* 6. Identify your practice model:

Family Health Group (FHG)

Fee for Service (FFS)

Family Health Network (FHN)

Family Health Organization (FHO)

Family Health Team – Family Health Network (FHT – FHN)

Family Health Team – Family Health Organization (FHT – FHO)

Comprehensive Care Model (CCM)

Community Health Centre (CHC)

Rural Northern Physician Group Agreement (RNPGA)

GP Focused Practice

Other (please specify):