New supporter survey

I witnessed the suffering of a loved one who would have wanted the option of a peaceful death

I have a disease, condition or diagnosis and want to make sure I have the option of assisted dying

I feel strongly that having the option of assisted dying is a patient’s right — one that must be protected

Other (Let us know in the feedback form for Question #3)

First Name

Last Name

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Address (Street, City, Province, Postal code)