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Patient Family Advisor Application

The Patient and Family Advisory Council (PFAC) is a new committee that combines patients and families with the healthcare team. This council provides advice on ways to improve the patient and family experience within our system. Our goal is to instill the customer’s point of view with our service, quality and safety improvements.

Requirements to Volunteer:

* 18 years of age or older

* Patient or family member of a patient, who received healthcare (hospital, clinics, rehab, lab, imaging, etc.) within the past 3 years

* Be able to attend regular meetings (occur on the 2nd Thursday of every month)

* Membership duration of two (2) years that can be renewed for a span of four (4) years. (Term subject to change)

If this committee appeals to you, please fill out and submit the following application. Thank you for your consideration.

Name *
Name
Address *
Address
Phone *
Phone
When was your care experience at this hospital? *
Check all that apply
Which unit(s) provided care for you or your family member? *
Check all that apply
You can still be an advisor if you answer "no".
How do you want to help? *
Check all of your interest areas.