Patient and Family Advisory Board Application

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Thank you for your interest in becoming a member of the UP Health System - Marquette Patient and Family Advisory Board (PFAB). The Patient and Family Advisory Board partners patients and families with members of the healthcare team to provide guidance on how to improve the patient and family experience. Through their unique perspectives, they give input on issues that impact care, ensuring that the next patient or family member’s journey is easier. Advisors provide feedback on projects, initiatives, and experiences, and share with us their philosophies and ideas for improvement. The Patient and Family Advisory Board typically consists of 10-12 community members.

All applications are reviewed by members of the board. Selections for interviews are made based upon expanding the diversity of the board, the applicant’s experience and perspective, availability for meetings, and the applicant’s desire to support our healthcare system.

First Name *

Last Name *

Street Address *

City *

State *

ZIP Code *

Home Phone *

Cell Phone *

Email Address *

Preferred contact method *

Home Phone

Cell Phone

Are you a... *

Patient

Family member of a patient

Other:

Why do you want to become a patient and family advisor? *

Please briefly describe any experience you may have as an advisor, as an active volunteer, or as a public speaker. *

Thinking about your healthcare experiences, please describe any specific things that doctors or hospital staff did or said while you or your family member were in the hospital that were helpful to you or your family. *

Thinking about your healthcare experiences, please describe any specific things that doctors and hospital staff could have done differently to be more helpful while you or your family member were in the hospital. *

Our patient and family advisors reflect the diversity of the patients we serve. Please share anything about yourself that you think would add to the diversity of our team of advisors. *

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