Tell us a little bit about your care setting

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1. What best describes the setting in which the toolkit would be implemented?

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2. What is your area of practice in this setting?

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3. What age are your patients or clients (check all that apply)?

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4. a) What province or territory do you work in?

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5. Please indicate your current role (check all that apply):

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6. What statement best describes you or your care setting’s knowledge of virtual care?

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7. Please give us a sense of your intention to implement virtual care in your care setting

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8. a) What technology are you using or intending to use as part of virtual care (check all that apply)?

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9. In what format(s) are you implementing or planning to implement virtual care?

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10. Thank you! A member of our team will email you the current version of the toolkit within 48 hours. We will also email you when we release new versions of the toolkit in the future, as well as a survey to seek your feedback on the toolkit. Your email will not be shared to third parties or used for purposes other than to distribute or evaluate the toolkit. Please provide your name and email here:

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11. Our goal is to continually improve the implementation toolkit. We would like to speak to some of the toolkit users to get more detailed feedback. Would this be ok with you?

If you have questions, please contact: Dr. Meiqi Guo: meiqi.guo@uhn.ca Or Angie Andreoli: angie.andreoli@uhn.ca
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