Commitment to Change

The personal information collected through this form will be used for the purposes of following up with you to discuss action plans around areas identified in the session. The information you share with us will be compiled with that of other supervisors for analytic and reporting purposes. The collection of this information is authorized under Section 33(c) of the Freedom of Information and Protection of Privacy Act and the privacy protection provisions of that Act will protect it.

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This commitment to change form is provided to you by the Physician Learning Program

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