Orientation to the Canadian Health Care System

Registration

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First Name*

Last Name*

Email*

Affiliation*

Phone*

Name used (if different from first name) (optional)

Middle Name (please put N/A if you do not have a middle name)*

Pronouns (optional)

Emergency Contact Name*

Emergency Contact Phone Number*

Street Address*

City/Town*

Postal Code*

Province/Country*

In what country did you complete your degree/diploma/other education in health care?*

Employee Number (please enter N/A if you are not a Nova Scotia Health employee)*

Please indicate which zone you live in:*

Have you previously practiced in the Canadian health care system?*

Current employer * (please enter N/A if not employed)

Professional Designation*

Years of experience in Professional Designation*

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