Create Clinician Posting – Social Health and Equity Network for Primary Care Canada

Clinician Details

Username *

(for account setup purposes only - this will not be publicly displayed)

Preferred Email Address *

(for professional, non-clinical communication - this will not be publicly displayed)

Enter Listing Details

Consent to share information and join mailing list *By completing this form, you consent to your name being publicly displayed on our website; people contacting you through the website’s communications feature (your email will not be displayed and you will have a choice as to whether to respond directly and provide contact information); your first and last name, practice location (as shown on a map; your address will not be displayed), areas of interest, practice models, and professional designations being viewable and searchable to users of the website. You also consent to be added to the website mailing list. You may unsubscribe from this mailing list at any time.

Full Name *

Enter your first and last name

Contact Form Email

You can enter the contact email for your listing.

Phone Number (optional)

(for professional, non-clinical communication - this will not be publicly displayed)

Website

(optional)

Professional Affiliations

(optional; this will not be searchable, but will display in your profile)

Short bio

(optional; this will not be searchable, but will display in your profile - a chance to describe your work and interest in action on SDOH and health equity)

Your areas of interest in addressing health inequities and social determinants of health in primary care are: *

Advocacy and Social Policy DevelopmentClinical Intervention Development and/or ImplementationEducation (undergraduate, postgraduate, continuing professional development)Health Care Institutional ChangeResearch

(select all that apply)

Default Category *

The default category can affect the listing URL and map marker.

Practice Details

Do you have additional practice sites 50+ km from your primary practice site?

Yes

Tick "Yes" if you have multiple practice locations separated by 50km or more.

Practice Site Name

Enter name of site or practice (if applicable)

Practice Site Address *

Please enter the listing street address. eg. : 230 Vine Street

Region *

Click on above field and type to filter list or add a new region.

City *

Click on above field and type to filter list or add a new city.

Postal Code

Please enter listing Postal Code

Click on "Set Address on Map" and then you can also drag map marker to locate the correct address

Questions or comments

Is there anyone else in Canada we should reach out to for inclusion in this community? Please provide first and last names and email addresses.

Type 64 into this box

Preview Listing