Peer Guide Application Form Page

Your Personal Information - Please provide your contact information below.

When did you start practising as a family physician (year)? *(Required)

Please enter a number from 1900 to 2023.

OCFP programs strive to represent the full range of our membership, including all practice types and regions of the province. Please tell us your location and your practice type.

If other, please state:

Your answers to the following questions will help us to better understand how you can support your colleagues through Peer to Peer Connect. You do not need to be an expert in mental health, substance use disorders, chronic pain and physician wellness to be a Peer Guide.

What skills have you developed that you’d like to assist colleagues in developing/strengthening?*(Required)

What are some areas of practicing (related to mental health, substance use and chronic pain) that you’d like to share with colleagues/support colleagues in learning?*(Required)

(for example, addressing symptoms of Long COVID, addressing symptoms of irritable bowel syndrome etc.)

In the role of Peer Guide, how would you hope to support colleagues experiencing symptoms of burnout?

Describe why you are interested in becoming a Peer Guide.*(Required)

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Phone

This field is for validation purposes and should be left unchanged.