Physician Peer Support Request

To speak with a Peer Supporter, please fill out the form below. Your information and use of the program will be kept confidential – only viewable by the Peer Supporter and program administrator for the purpose of facilitating a match. Your Peer Supporter will reach out to you as soon as possible. If you have any questions, please contact support@vernonmsa.ca.

Confidentiality

The peer support program is structured to ensure privacy and does not report to any VJH department. Any information submitted through this website will be kept confidential (only viewable by the Peer Supporter and program administrator for the purpose of facilitating a match).

Name
Preferred method of contact
Preferred modality of peer support
Best time of day to contact you
What career stage are you in?
Reason for referral