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Contact Information and Demographics
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First name
Last name
Email
Phone
City
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Province
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Are you a patient or a caregiver?
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Visit Month
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Visit Year
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Which hospital did you visit?
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Hospital Engagement
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Which type of hospital encounter did you have on your most recent visit?
Outpatient clinic visit (in person or virtual)
Emergency department (in person or virtual)
Inpatient admission
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