CAGP Mentorship Profile
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Please provide your name.
Please provide your preferred method of contact (phone or email).
What province do you practice in?
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
New Brunswick
Nova Scotia
PEI
Newfoundland and Labrador
Yukon Territories
Northwest Territories
Nunavut
Where did you get your medical degree?
Where did you complete your residency?
How long have you been a practicing physician?
Have you participated in any other professional development or education training?
Have you, or are you currently involved in any research initiatives?
What are your areas of specialty (provide all that apply)?
How many medical learners are you willing to mentor?
How would you like to connect with your mentee? (select all that apply)
In-Person
Tele-conference
Video-conference
Email
Other (please specify):
Why do you want to participate in this program?
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