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Graduation year:	Please choose a year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Profession*:	Please indicate your profession Family Physician Specialist Physician Research or Scientist Other Health Professional Not Health Related
Years in Profession*:	Please indicate the number of years 5 years or fewer 5 to 10 years 10 to 20 years 20 to 30 years 30 years or more
Specialty*:	Please indicate your specialty or indicate that you have none I have no specialty or am not a health professional Acute Leukemia Addiction Worker Adolescent Medicine Allergist Anaesthetist Anatomic Pathologist Anatomist Anesthesiologist Audiologist Behavioural Medicine Biochemist Biologist Biomedical Engineer Biophysicist Biostatistician Cardiologist (m) Cardiology, Palliative Care Cardiothoracic (s) Cardiovascular (s) Cell Biologist Chaplain Chief Chief Information Officer Child Psychiatrist Chiropodist Chiropractor Clergy Clinical Anatomist Clinical Biochemist Clinical Coordinator Clinical Director Clinical Educator Clinical Geneticist Clinical Pathologist Clinical Pharmacist Clinical Physicist Clinician Clinician Teacher Colorectal Surgeon (s) Community Medicine Consultant Counsellor Cytogeneticist Cytotechnologist Dental Hygienist Dentist Dermatologist (m) Detective Dietitian Director Dosimetrist Editor Educator Emergency Physician Endocrinologist (m) Environmental Health Epidemiologist Ethicist Faculty Faculty Development Leader Family Physician Fellow Forensics Funeral Director Gastroenterologist (m) General Surgeon (s) Genetic Counsellor Geneticist Geriatric Nurse Geriatrician (m) Gerontologist Haematologist (m) Haematopathologist Hand Therapist Health Administrator Health Prof. College Director Health Prof. Program Director Healthcare Leader Healthcare Prof. Dev. Leader Immunologist Infectious Diseases Internal Medicine Internal Medicine (frcpc) Internal Medicine (m) International Med Grad Internist (m) Investigator It Managers Judge Kinesiologist Lawyer Mammographer Manager Massage Therapist Media Medical Biologist Medical Biophysicist Medical Consultant Medical Director Medical Educator Medical Geneticist Medical Herbalist Medical Historian Medical Illustrator Medical Imaging Medical Lab Technologist Medical Oncologist (m) Medical Physics Medical Writer Microbiologist Midwife Molecular Biologist Molecular Cardiologist Molecular Imaging Molecular Oncology Naturopath Neonatologist Nephrologist (m) Neurologist (m) Neuroradiologist Neuroscience Neurosurgeon (s) No Specialty Nuclear Medicine (m) Nurse Nurse Educator Nurse Practitioner Nutritionist Obstetrician/gynaecologist Occupational Medicine (m) Occupational Therapist Ocular Oncologist Oncologist (m) Ophthalmologist Optician Optometrist Oral Surgeon Orthodontist Orthopaedic Medicine Orthopaedic Surgeon (s) Orthoptist Orthoptist Orthotic Technician Orthotist Ot (occupational Therapist) Other Otolaryngologist Pacs Administrator Paediatric Cardiologist Paediatric Haematologist Paediatric Neurologist Paediatric Oncologist Paediatric Radiologist Paediatric Surgeon (s) Paediatrician Palliative Care Palliative Care Physician Paramedic Pathobiologist Pathologist Pediatric Hematology Oncologist Pediatric Neurosurgeon Pediatric Ophthalmologist Perinatologist Pharmacist Pharmacologist Physiatrist Physical Therapist Physician Physicist Physics (m) Physiologist Plastic Surgeon (s) Podiatrist Police Constable Post-Grad Healthcare Educator Prenatal Medicine Press Preventive Medicine Professor Psychiatrist Psychoanalyst Psychologist Psychometrist Psychosocial Psychotherapist Pt (physical Therapist) Public Health Sciences Rabbi Radiation Oncologist Radiation Therapist Radiography Radiologist Reflexologist Registered Nurse Registered Technologist Rehab Coordinator Research Assistant Researcher Resident Respiratory Therapist Respirologist (m) Retired Rheumatologist (m) Social Worker Sociologist Sonographer Sonologist Speech Pathologist Sports Medicine Student Supervisor Surgical Oncologist (s) Technician Technologist Therapist Thoracic Surgeon (s) Under-Grad Health Prof. Leader Urologists (s) Vascular Surgeon (s) Veterinarian
Please indicate your College membership *:	Please indicate your College membership or indicate that you have none None Ontario College of Family Physicians Royal College of Physicians and Surgeons of Canada
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