Email Address*
 
 
Confirm Email Address*
 
 
 
First Name*
 
 
Last Name*
 
 
 
Region (Province/Territory)*
 
 
Preferred Language of Correspondence
 
 
What is your current gender? Gender refers to a person’s internal, felt, and psychological sense of self and understanding of their gender. Only the individual person can determine their gender identity terms and labels***
 
 
If you selected that you would like to self-describe, please describe below:
 
 
 
What areas of work are you most interested in contributing to as a part of the HEC Patient Partner Network?
 
 
 
What do you hope to gain/achieve/learn by being a part of this network?
 
 
 
Is there anything else you would like to share with us?
 
 
 

If you wish to meet a member of the Patient Safety, Equity and Engagement team on how we can support you, please email patientpartnership-partenariat@hec-esc.ca.

**Healthcare Excellence Canada (HEC) is a not-for-profit organization funded primarily by Health Canada. HEC recognizes and deeply respects the diversity of gender identities. We are dedicated to ongoing growth and learning regarding the responsible collection, utilization, and safeguarding of data and information about people. HEC also collects this information as required by our Contribution Agreement with Health Canada due to an increasing focus on gender-based analysis. This data is also reported in an aggregate format across all HEC programming, initiatives, and activities.

By submitting this form, you are consenting to from Healthcare Excellence Canada’s Patient Partner Network. You can update your information or unsubscribe from our mailing list at any time by using the unsubscribe link found at the bottom of every email.

We do not sell or rent contact information. Learn more about how we use personal information in our Privacy Policy.

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