Patient and Family Experience Council Member Application

Thank you for your interest in becoming a Partner of AdventHealth's Patient and Family Experience Council for the Cardiovascular Institute. We want to work together to enhance the patient experience by hearing our partners’ stories and perspectives. Together, this partnership will help advance AdventHealth’s promise of whole-person health care.


Help us get to know you better:

Are you a patient, a patient's family member, part of AH Staff, or a Physician?
When was your care experience with AdventHealth? (Check all that apply)
Which AdventHealth services have you/your family member experienced? (Check all that apply.)
Check all areas of help that you are interested in.
Please check all experience—personal or professional—that would contribute to being a Patient and Family Experience Partner:

Please name a personal or professional reference, or an AdventHealth team member who knows you and/or your family member.


I agree that AdventHealth may use email to communicate with me regarding the Patient and Family Experience Partners program. I understand that email is not a secure medium for sending and/ or receiving potentially sensitive personal health care information. AdventHealth cannot assure the confidentiality or protection of email communications, particularly if the emails are sent to multiple individuals participating in the Patient and Family Experience Partners program. In addition, email sent to AdventHealth may be accessed by individuals who are not directly involved (for example, by my employer if my email address is provided by my employer, or by my internet service provider).

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