Do you want to make a real difference in the health and social services network?
Do you want to get involved in your community? 
 
 
To apply to become a citizen partner with the Montréal West Island CIUSSS, please answer the questions below. The questionnaire should take about 4 minutes to complete.   

*Please note that Montreal West Island IUHSSC employees are not eligible to participate, however, we would like to thank you for your interest in the activities of the Citizen Partner Office

Question Title

* 1.  Do you work for the CIUSSS de l’Ouest-de-l’Île-de-Montréal? 

Question Title

* 2. Name

Question Title

* 3. Email

Question Title

* 4. Phone number

Question Title

* 5. In what city/borough do you live? 

Question Title

* 6. What gender do you identify as? 

Note: As provided by Statistics Canada, transgender, transsexual and intersex Canadians should indicate the gender (male or female) with which they most identify. 

Question Title

* 7. What is your age group? (Minors are excluded)

Question Title

* 8.  What health-related issues interest you? 

Question Title

* 9. What is your motivation for becoming a citizen partner?

Question Title

* 10. How did you hear about the Citizen Partner’s Office? 

T