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Apply for the conversation group and/or survey for palliative care for patients and their caregivers

Thank you for your interest in participating on this project. We have a some questions for you to ensure that the opportunity is a good fit for you. Please click the 'submit' button to complete your application and a team member will connect with you. 

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Maximum 255 characters

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4.  

Are you one of the following?

* required
Select option
6.  

Do you live in one of the following communities that Vancouver Coastal Health serves?

* required
The pilot program will only serve Vancouver residents at this time but if you wish to contribute your experience from another urban context, we would like to hear from you.
7.  

Are you interested in participating in the conversation group, the survey or both?  

* required
8.  

When are you most likely to be available (please check all that apply)?

Select option
Transcription: a feature that provides a written record of what is said during a meeting or call; Anonymous: not named or identified