We welcome patients and family members to provide feedback on their hospital experiences with Loyola Medicine Hospitals, including MacNeal. The Patient and Family Advisory Council works to promote and enhance patient/ family-centered care throughout our organization.

Please complete each section of this form so that we can learn more about you and your experience with Loyola.

Thank you for your interest in joining the Patient and Family Advisory Program!

Name


Contact Information


Tell us more about yourself

Is there any information you would like to share with us in considering your application? Skills, past experiences, availability, etc.


Your experience

What would you like us to know regarding your past experience(s) receiving care at Loyola University Health System?


Why are you interested in serving as an Advisor?

Please tell us why you interested in serving as a Patient Experience Advisor.


Department of Services

Have you or family members had experiences with Loyola University Health System that you would be comfortable in discussing and helping us improve or expand? Please indicate where those services were received. Check all that apply.


Patient Experience Advisor Opportunities

Your participation in helping us improve patient care policies, processes, communication materials, the physical environment, quality improvement activities, and safety efforts, will have a direct impact on our patients' experiences while receiving care in the hospital, or at any of our facilities.

Based on your area of interest and/or expertise, we offer the following opportunities. Please select the way(s) you are interested in serving.


Agreement

I understand and agree that this application form does not automatically register me as a Patient Experience Advisor, and that there may be certain qualifications I must meet before I may begin volunteering.