Email address*
 
 
Confirm Email Address*
 
 
 
First Name*
 
 
Last Name*
 
 
 
City/Town
 
 
Region (Province/Territory)
 
 
 
Primary Role in Healthcare
 
 
Title
 
 
 
Organization or regional health authority
 
 
Site(s)
 
 
 
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:
 
 
 
Sector
 
 
If you selected Other, please describe below:
 
 
 
How did you hear about Canadian Patient Safety Week?
 
 
Why are you registering for Canadian Patient Safety Week?
 
 
 
To help us evaluate the impact of Canadian Patient Safety Week, please answer the following questions: 
 
 
 
What comes to mind when you think of healthcare harm?
 
 
 
What is one thing you do to prevent harm and create safer care?
 
 
 

**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 consent to receiving marketing emails from Healthcare Excellence Canada. 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. Learn more about how we use personal information in our Privacy Policy.