Hospice Waterloo Region, in partnership with Hospice Wellington, is leading a project to raise awareness and engagement in Advance Care Planning throughout Waterloo Region and Wellington County.

We are conducting this community-wide survey to help us better understand residents’ awareness, understanding and behavior related to Advance Care Planning.

Don’t worry if you haven’t given this topic much thought before. We’re interested in understanding what the community knows – and doesn’t know – about Advance Care Planning. We are aiming to reach at least 250 residents though this survey.

Your participation is extremely valuable and will help inform the development of ACP education in your community.

To thank you for your time you will be invited to enter a draw for a Tim Horton's $10 gift card upon completion of the survey.

Your participation is anonymous and voluntary. Survey responses will be used to prepare a summary of the research findings. Your name will not be linked to any of your responses and any identifying information will be removed.

Research findings will be shared with project partners in the health care sector and community.

Completing the survey should take about 10 minutes.

If you have any questions about this survey or the ACP Education Program, please contact Sheli O’Connor at sheli@hospicewaterloo.ca or 519-743-4114 ext 111.

* 1. Do you understand the information above and agree to participate in the survey?