Women's Heart Health Community Presentation - Request Form

The Canadian Women's Heart Health Centre (CWHHC) is proud to offer free in-person and online community presentations. The presentation covers:

What heart disease is;
How heart disease is different in women, including signs and symptoms;
Risks for heart disease;
How you can take heart health action;
Tips for talking with your health care providers

The session is one hour in length (45 min presentation + 15 min Q&A) and is lead by a CWHHC Community Advocate. Many of our presenters are women with lived heart experience, as well as others who are passionate about the issue.

Please note, we will do our best to fulfill your request, however some modifications may be needed depending on the availabilities, capacities and locations of our presenters.

After submitting your form, the CWHHC will review your request and contact you with next steps within 2 weeks.

Questions? Please email: cwhhc@ottawaheart.ca. Thank you!

Question Title

* 1. Your Information

Organization/Company/School (if applicable)

Contact Name

Phone

City

Province/Territory

Question Title

* 2. When would you prefer to have the presentation? Please include any date(s), or date range, time, or let us know if your schedule is flexible.

Question Title

* 3. Do you prefer an in-person or virtual presentation?

In person

Virtual

Either

Question Title

* 4. If in-person, please indicate the location, if known (ex. name of venue, address).
* Please note, we will do our best to fulfill your request, however some modifications may be needed depending on the availabilities, capacities and locations of our presenters.

Question Title

* 5. How many attendees do you expect (rough estimate)?

1-10

11-25

26-50

50+

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* 6. Which language you prefer the presentation to be conducted in?

English

French

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* 7. Please tell us more about your organization/company/school.

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* 8. What are the reasons for requesting a presentation on women's heart health?

General health education and personal development

Learn about the causes of heart disease for women

Learn about specific risks of heart disease for women

Learn how women can reduce the risk of heart disease

Our group does work in a related field (ex. health, women's health, etc.)

Other (please specify)

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* 9. Where did you hear about the Women's Heart Health Community Presentations?

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* 10. Additional Comments:

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* 11. Would you like to receive occasional women's heart health newsletters?

Yes

Question Title

* 12. If yes, please provide the following information:

Name

Email Address

By submitting this request form, you agree to the following liability release:

In consideration for participating in the Women's Heart Health Community presentation, the receipt of said participation being hereby acknowledged, I do hereby forever release any and all liability, discharge, and agree not to sue the University of Ottawa Heart Institute , its representatives, directors, officers, employees, agents, affiliates, successors and permitted assigns (“UOHI”) and/or any other supporter or contributor to the program, and agree to hold and save them harmless and indemnify them from and against any and all liabilities, claims, injuries, losses, damaged, expenses, demands, actions, and causes of action of whatsoever kind or nature arise out of or related to any such loss, damage or injury that may be sustained by me for whatever reason while participating in the Women's Heart Health Community presentation or upon the premises or grounds where the presentation takes place or through the online platform where the Women's Heart Health Community presentation videoconference takes place, whether such damages are the result of negligence or for any other reason.

Question Title

* 1. Your Information

Question Title

* 2. When would you prefer to have the presentation? Please include any date(s), or date range, time, or let us know if your schedule is flexible.

Question Title

* 3. Do you prefer an in-person or virtual presentation?

Question Title

* 4. If in-person, please indicate the location, if known (ex. name of venue, address).* Please note, we will do our best to fulfill your request, however some modifications may be needed depending on the availabilities, capacities and locations of our presenters.

Question Title

* 5. How many attendees do you expect (rough estimate)?

Question Title

* 6. Which language you prefer the presentation to be conducted in?

Question Title

* 7. Please tell us more about your organization/company/school.

Question Title

* 8. What are the reasons for requesting a presentation on women's heart health?

Question Title

* 9. Where did you hear about the Women's Heart Health Community Presentations?

Question Title

* 10. Additional Comments:

Question Title

* 11. Would you like to receive occasional women's heart health newsletters?

Question Title

* 12. If yes, please provide the following information:

* 4. If in-person, please indicate the location, if known (ex. name of venue, address).
* Please note, we will do our best to fulfill your request, however some modifications may be needed depending on the availabilities, capacities and locations of our presenters.