Application FormHunterdon Healthcare, New Jersey 2025

1. Click ‘Get Form’ to open the Application Form for Patient and Family Advisors in the editor.
2. Begin by entering your name in the designated field at the top of the form. Ensure that it is spelled correctly for accurate identification.
3. Fill in your address, including city, state, and zip code. This information is crucial for communication purposes.
4. Provide your home and cell phone numbers. This allows the advisory council to reach you easily.
5. Enter your email address in the specified field to facilitate electronic communication.
6. Indicate whether you allow your contact information to be shared with other Advisory Council members by selecting 'Yes' or 'No'.
7. Select your status as either a patient or a family member of a patient by checking the appropriate box.
8. Detail any services you or your family member have used at UVMHN-Porter Medical Center within the last two years in the provided space.
9. Explain why you are interested in serving as an advisor in the designated section.
10. List your availability for meetings by checking all applicable times: Daytime, Evenings, or Weekend.
11. If applicable, describe any previous experience as an advisor or volunteer in the provided area.
12. Share specific instances where healthcare professionals were particularly helpful to you and your family.
13. Finally, provide suggestions on what healthcare professionals could do differently to improve their service.

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