Thank A MAiD Professional FormThank a MAiD Professional - Submission Form Step 1 of 520%Many families and loved ones feel deep gratitude for the healthcare professionals who supported their loved one through a MAiD journey.This program provides a meaningful way to recognize those professionals. You may share a message of appreciation and, if you wish, make a charitable donation in their honour to support CAMAP’s work strengthening education and support for MAiD professionals across Canada. Participation is voluntary, and you may choose to remain anonymous.About the MAiD Professional You Are HonouringName(s) of the MAiD Professional You Wish to Thank(Required)If there is more than one member of the MAiD team that you wish to thank, please add them.What was their role?(Required) MAiD Provider MAiD Assessor Nurse Navigator Social Worker Care Coordinator OtherProvince or Territory of the MAiD Professional(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonCity where this care took place(Required)Where did this care take place?(Required)Example: Name of hospital/clinic/facilityMAiD Professional contact information (if available)e.g., email address or phone numberYour Message of GratitudeWould you like to share a message of appreciation? (optional)You may share why you would like to thank this MAiD professional or what their care meant to you or your loved one.May CAMAP share your message with the MAiD professional?(Required) Yes Yes, but please remove my name NoMay CAMAP use your message anonymously in program stories or communications?(Required) Yes No(Example uses include program awareness, educational materials, or impact reports.)Optional DonationMany people choose to accompany their message of gratitude with a charitable donation that supports CAMAP’s work strengthening education, peer support, and professional development for MAiD professionals across Canada.The donation amount is confidential and will not be shared with the MAiD professional.Making a donation is optional.Would you like to make a donation to CAMAP in honour of this MAiD professional?(Required) Yes NoThank a MAiD Professional suggested donation levels $500 CAD $250 CAD $100 CAD I'd like to donate a different amountOther Donation Amount Would you like to cover the 3.5% processing fee so your full donation goes to CAMAP?(Required) Yes, please No, thank youProcessing Fee Price: $ 0.00 CAD Total Upon completing this form, you will be redirected to a secure page to complete your payment.About YouYou may choose to remain anonymous.Name (optional) First Last Email(Required) (Used only to confirm receipt of your submission)Your relationship to the person who received MAiD. (optional) Spouse or partner Child Parent Family member Friend OtherPrivacy & ConsentTo protect the privacy of patients and families, please avoid including identifying personal health information in your message.Consent(Required) I understand that CAMAP may share my message with the MAiD professional I am honouring if I have given permission above.Consent(Required) I confirm that I have not included identifying health information in my submission.
