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GENERAL INFORMATION / INFORMATIONS GÉNÉRALES

Province * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Saskatchewan Quebec

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Specialty / Spécialité * Rheumatologist Dermatologist Nurse/NP Pharmacist Other

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I give consent to RheumConnect: A virtual network for Canadian rheumatologists to use this information to build a profile when my request is approved. *