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Caregiver Research Focus Group Registration
*THIS FORM IS NO LONGER ACCEPTING RESPONSES*
Please leave your name and contact information if you would like to be contacted for future patient/caregiver engagement opportunities with the AOHT.
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* Indicates required question
Full Name (Please indicate first and last name)
*
Your answer
I understand that by enrolling in this focus group, I will be invited to participate in a
Caregiver Research Study
conducted by Algoma Ontario Health Team and Algoma University researchers.
*Please note that this one-time focus group session will require up to 2 hours of your time. You will be provided with additional information and have an opportunity for your questions to be answered prior to participation.
By participating in this focus group, you will be offered remuneration in recognition of your time and sharing your lived experience expertise.
*
Yes
No
Maybe (I require more information before deciding and agree that an AOHT or Algoma U member can reach out with additional details)
Please indicate the first three digits in your postal code (Please note that this is to ensure we are reaching a wide array of individuals located in the Algoma region).
Your answer
What type of focus group meeting format are you interested in participating in?
*
In-person
Virtual
Required
Preferred method of contact (phone or email). Please provide your phone number or email address.
*
Your answer
Are you a registered caregiver in the Caregiver ID program?
*
Yes
No, but I am familiar with the program
No, and I am NOT familiar with the program
If you answered yes to the above question, please specify what organization you are enrolled with (if you feel comfortable in doing so).
Your answer
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