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Nurse form EN
1
Select your professional Order
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OIIQ
OIIAQ
OPTMQ
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2
What is your member number?
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3
How many years of experience do you have in blood test sampling?
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4
What are your main motivations for getting started in the Medialpha program?
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Control my schedule
Additional income
Work-family balance
Better work conditions
I've been thinking about it
I want to be my own boss
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5
Have you thought about launching a blood test sampling business?
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YES
NO
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6
In your opinion, do you see a problem with home blood test in Quebec?
*
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YES
NO
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7
Do you think that home blood test can make an important contribution to improving Quebec's health care system?
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YES
NO
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8
When would you be ready to begin?
*
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Today
1 to 3 months
Within more than 4 months
I just want information for now
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9
Do you have a car?
*
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YES
NO
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10
What is your name?
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First name
Last name
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11
What is your primary contact phone number?
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Area code
Phone number
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12
What is your email address?
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exemple@exemple.com
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13
In what city/area do you live?
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14
Do you have an invitation code?
Optional
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