Request a Speaker/Presentation

There are many clinicians and volunteers in the region who are able to offer presentations on a variety of topics to interested groups. If you would like our help to arrange a speaker for you, please complete the following form.

Your Information

Name*

First Last

Phone*

Email*

Select Your Topic

Topic*

Preferred Date and Time

First Choice*

Time

: Hours

Mins

Second Choice*

Time

: Hours

Mins

ADDRESS
Champlain Hospice Palliative Care Program
69 Primrose Avenue, Annex C, St-Vincent Hospital
Ottawa, Ontario
K1R 6M1

PHONE
Phone: 613-683-3779

FAX
Fax: 613-683-3778

Request a Speaker/Presentation

Your Information

Select Your Topic

Preferred Date and Time

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