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E Mail: 

(for latest info, newsletters etc as it relates to COPD Canada)

Are You a   (please choose one)   Patient Support Person/Caregiver Family Member Friend Medical/Professional Other

How did you hear about

COPD Canada Patient Network? Internet Search A Link from Another Site Forum/Message Board Friend/Family Member Brochure/Pamphlet Other

(For Canadian Members) It is expected that as a Member of COPD Canada Patient Network you will agree to participate in at least 2 major mail campaigns annually.  These mail campaigns may be to a newspaper, a member of parliament or minister etc. One letter; at least twice a year.

Do you agree to this?    YES    NO 

(For Canadian Members:)  We are trying to compile some provincial info re: the coverage of certain meds that are "accepted" on their Pharmacare program.

 Do you KNOW  if the following medicines are covered in your province within your Pharmacare programs? (Choose all that apply or leave blank if unsure)

Advair Oxygen Spiriva Symbicort

  Your province?  AB BC MB NB NL n/a NS ON PE PQ SK Terr

(For Canadian Members:)  We are also trying to compile a list of  Resources (by province) for Rehab & Support Groups (i.e. Better Breathers groups) for COPDer's even if NOT sanctioned/put on by, or organized by,  the Lung Association. 

Does your province have any that you're aware of?

 YES         NO          UNSURE

Who are they and where are they located?

Comments?

 Something you might be interested in: (For Canadian Members)

 It is our hope to have a representative in every province.  Currently we have physical representation in only 6 provinces . We are  seeking additional representatives.  It would be expected that you would know, or are willing to find out,  the resources available as it pertains to COPD for your province.  You would ultimately be the "resource person" for that province. 

Do  you feel this is something you might be interested in?

YES       NO       NOT SURE  

Please choose, from the Drop Down Menu your province if you answered YES to the above Question      AB N/A MB PE SK Terr

Thank You & Welcome to COPD Canada Patient Network!