HELP Volunteer Physician - Intake Form

Thank you for expressing an interest in volunteering.

Any information you provide in this survey will remain private and confidential. None of your information will be shared without your express consent.

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* 1. Full Name:

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* 2. Email address:

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* 3. Phone number:

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* 4. Are you currently residing in Canada?

Yes

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* 5. City/Town:

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* 6. Medical area(s) for which you prefer to help with medical English [select all that apply]:

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* 7. What year did you graduate from medical school?

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* 8. Are you currently

Working full time

Partially retired

Retired

Other (please describe)

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* 9. Which meeting format do you prefer?

In-person sessions

Virtual sessions

Either in-person or virtual sessions are okay

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* 10. Can you make a commitment to meet with a Newcomer Physician for 12 one-hour sessions, meeting approximately once per week?

Yes

HELP Volunteer Physician - Intake Form

Thank you for expressing an interest in volunteering.

Question Title

* 1. Full Name:

Question Title

* 2. Email address:

Question Title

* 3. Phone number:

Question Title

* 4. Are you currently residing in Canada?

Question Title

* 5. City/Town:

Question Title

* 6. Medical area(s) for which you prefer to help with medical English [select all that apply]:

Question Title

* 7. What year did you graduate from medical school?

Question Title

* 8. Are you currently

Question Title

* 9. Which meeting format do you prefer?

Question Title

* 10. Can you make a commitment to meet with a Newcomer Physician for 12 one-hour sessions, meeting approximately once per week?

* 6. Medical area(s) for which you prefer to help with medical English [select all that apply]: