Please complete this application form if you are interested in joining our Patient and Family Advisory Council. Once you complete the form, click the continue button at the bottom.


Name and Address


All About You

Are you currently or have you been a patient or family member of a patient at an Orlando Health facility within the last 2 years?



Rate your Experience

Would you describe your experience with Orlando Health as positive, negative, neutral or other?



Your Journey

Please tell us about you or your family member's healthcare experience at Orlando Health.



Feedback

In what way could we have improved your experience during your time with us?



Questions?

Please contact Kendall Hirst for any questions you may have.

(407)649-6946

kendall.hirst@OrlandoHealth.com



Agreement to Serve

I understand that the completion of this application does not bind the applicant or the program coordinators in any way, and that the Council reserves the right to choose participants that best meet the needs of the program. Before participating in Orlando Health's Patient and Family Advisory Council, I understand that this is a volunteer position and that I will not be paid for my service on the PFAC, and that I further understand that this is a two year participation agreement and that I may be asked to step off the council before, during or when the duration of my term agreement expires. Lastly, I understand that I will be asked to sign a confidentiality agreement form.