This survey serves as your online application to join the OCFP's online community of practice for Palliative and End of Life Care.

This community of practice is open to physicians – including family doctors and specialists – pharmacists and nurse practitioners in Ontario, facilitating access to palliative and end-of-life experts and peers for case-based support and education. It is part of the OCFP’s Collaborative Mentoring Networks, supported by the Ministry of Health and Long-Term Care. Email ocfpmentoring@ocfp.on.ca to learn more.

Later in this survey, you will have the opportunity to indicate your interest in joining the Palliative Care Collaborative Mentoring Network as a Mentor or Mentee, or participating in the Community of Practice only.

The survey collects demographic information about you and your practice as well as your learning needs for continuing medical education. The information you provide will help shape future program development. Thank you in advance for your participation.

About You

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* 1. Full name:

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* 2. Active email address which you regularly check:

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* 3. Your year of birth:

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* 4. Years in practice:

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* 5. You are:

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* 6. Which best describes you?

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