This survey has two sections. Contact info helps us follow up if needed. Hospital engagement questions adapt to your visit type.
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Contact Information and Demographics
First name
Last name
Email
City
Select a city
Province
Select an option
Are you the patient or the caregiver?
Select an option
Visit Month
Select an option
Visit Year
Select an option
Which hospital did you visit?
Select a hospital...
Hospital Engagement
Please select your hospital encounter type to continue.
Which type of hospital encounter did you have on your most recent visit?
Outpatient clinic visit (in person or virtual)
Emergency department
Inpatient admission
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