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I need to
Back
I need to
Book an appointment
Go to the emergency
Go to the hospital
Find a clinic or a service
Register for a family doctor
Get a hospital card
Make a comment or complaint
Visit a patient
Patients, parents and visitors
Back
Patients, parents and visitors
General information
Patient information
Resources for families
Clinics and services
Back
Clinics and services
Clinics
Services for hospitalized patients
Support services
Staff Directory
Healthcare professionals
Back
Healthcare professionals
Continuing Professional Development
Referrals
Resources for healthcare professionals
Resources for staff
Careers and volunteering
Back
Careers and volunteering
Careers
Volunteering
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Research
Teaching
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TEST PAGE – Patient Partnerships form
TEST PAGE – Patient Partnerships form
Partenariat avec les patients
Nom
(Required)
Prénom
Nom de famille
Courriel
(Required)
Entrez votre adresse courriel
Confirmer votre adresse courriel
Numéro de téléphone
(Required)
Langues parlées
(Required)
Français
Anglais
Autre
Disponibilités
(Required)
En semaine (vous êtes disponible occasionnellement entre 9h00 et 17h00 du lundi au vendredi)
Le soir (vous êtes disponible occasionnellement entre 18h00 et 21h00 du lundi au vendredi)
Autre
Quand votre enfant a-t-il été soigné ou a-t-elle été soignée pour la dernière fois à l'HME?
(Required)
DD slash MM slash YYYY
Dans quel service principal de l'hôpital votre enfant a-t-il été soigné?
(Required)
Pourquoi souhaitez-vous devenir patient partenaire?
(Required)
CAPTCHA
Patient Partnerships
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone number
(Required)
Languages spoken
(Required)
French
English
Other
Availabilites
(Required)
Weekdays (you are available occasionally between 9:00 a.m. and 5:00 p.m. Monday to Friday)
Evenings (you are available occasionally between 6:00 p.m. to 9:00 p.m. Monday to Friday)
Other
When did your child last receive care at the MCH?
(Required)
MM slash DD slash YYYY
In which main unit/department of the hospital did your child receive care?
(Required)
Why are you interested in becoming a family partner?
(Required)
CAPTCHA
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