Canadian FLS Network Registration | Osteoporosis Canada - Fracture Liaison Service

Title*

Name*

First Name Last Name

Email*

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Country*

Location in Canada*

Ville Province

Location*

Ville State / Region

Category*

Please select the category that best describes you:

Health care professional/clinician
Health care administrator/manager
Health care researcher
Other

Other Category*

Please specify the category that best describes you below

Type of Health Care Professional/Clinician*

FLS Coordinator
Orthopaedic surgeon
Nurse
Family physician
Nurse practitioner
Osteoporosis specialist
Other

Other Health Care Professional*

Please specify type of health care professional or clinician below

Type of Nurse*

Orthopaedic nurse
FLS Coordinator
Osteoporosis Clinic Nurse
Other

Other Nurse*

Please specify type of nurse below

Family Physician*

Check all that apply

I see patients in the hospital setting
I see patients in the community setting
I see patients in both settings

Nurse Practitioner*

Check all that apply

I am the FLS Coordinator
I see patients in the hospital setting
I see patients in the community setting
I see patients in both settings

Type of Osteoporosis Specialist*

Choose one

Endocrinologist
General Internist
Geriatrician
Gynecologist
Nephrologist
Rheumatologist
Family Physician with Expertise in Osteoporosis
Other

Other Osteoporosis Specialist*

Please specify type of osteoporosis specialist below

Level of Administration*

Please specify at what level of administration (check all that apply)

Local
Regional
Provincial
Hospital
Health Authority/District
Ministry/Department of Health
Long Term Care/Continuing Care/Home Care
Other

Other Level of Administration*

Please specify below

Position/Title

Optional

Research Interests*

Please specify your research interests below

My hospital currently operates an FLS

Yes, I am the FLS Coordinator
Yes, I am the FLS Medical Lead
Yes, I am the administrator for the FLS
Yes, I am one of the Orthopaedic Surgeons
Yes, I am one of the Osteoporosis Specialists
No, my hospital does not currently operate an FLS but we are interested in implementing an FLS

How did you hear about us?

By joining this network, you are agreeing to receive a regular newsletter on FLS related topics.

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Please enter any comments or questions below. If you would like to connect with other health care professionals regarding the implementation of an FLS, please connect with us via email at fls@osteoporosis.ca.