Pain Support Line evaluation interviews

Contact information

First name*

Last name*

Email address*

What time of day works best for you to participate in an interview?*

Select one or more time of day that works best for you.

Morning

Afternoon

Early evening

None of these times work for me

The following questions will help us determine if you meet the interview selection criteria.

How old are you?*

Are you a BC resident?*

Yes

No

Have you heard of Pain BC's Pain Support Line?*

Yes

No

Have you ever contacted Pain BC's Pain Support Line?*

Yes

No

The following optional questions will help us to select interview participants from a diverse range of communities, identities and experiences.

What is your gender?

Woman

Man

Non-binary

Other

Do you identify as any of the following?

Select all that apply.

LGBTQ2S

Newcomer to Canada or refugee

Black, Indigenous, Person of Colour