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CANADIAN PHYSICIAN COACHES NETWORK

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CPCN Directory Information Input Form

* Indicates required field

Last Name *

First Name *

Email *

Languages in which coaching is provided *

Non coaching credentials, degrees or fellowships *

City *

Province *

Coaching Certification or Training *

Areas of Coaching Interest (select all that apply) *

Worklife balance/wellness/burnout Career development and transitions Conflict Effective communication Female Physicians Leadership development and practice Professionalism Surgical/technical coaching Team Coaching Substance use/recovery

If clients wish to know more about you do use a website or do you wish to upload a resume? (Please pick one - if you wish to upload a resume you will be able to do so at the end of this form) *

Website Resume

If you have a website, please provide the full url, including http:// or https:// *

Personal Statement. Do not use this as bio; rather use it to make a statement that provides insight into your coaching approach *

Do you have any restrictions on clients that you accept? If not, enter "All" *

Photo. Pleaser provide a head shot laid out similarly to a passport photo. png, jpeg or tiff format only. File size between 200kb and 2 Mb preferred *

Max file size: 20MB

If you chose resume rather than website for clients to obtain more information about you, please upload it here *

Max file size: 20MB

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• career development • leadership • managing teams• professionalism • coping with conflict • finding wellness and joy • preventing or escaping physician burnout • phasing to retirement • anything where you need to leave your comfort zone

Home
Our Member Coaches
Our Board
Members only
Contact
Events
About CPCN