Patient and Family Advisor Application
I have been a Patient
I have been a family member of a patient
Why have you applied as a Patient and Family Advisor?
Which area(s) of the hospital are you most interested in supporting as a Patient Family Advisor?
It is the responsibility of the Brant Community Healthcare System to protect its patients and staff from any disease or infection, which might be brought in by new volunteers. For this reason all new volunteers must, as a condition of volunteer placement, receive a passing health review as required by the System, in accordance with the Public Hospitals Act and other legislative acts. Repeat examinations as required by legislation or the Hospital are mandatory.
WOULD YOU CONSENT TO A HEALTH REVIEW?
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE FOR WHICH A PARDON HAS NOT BEEN GRANTED?
IN CASE OF EMERGENCY PLEASE NOTIFY:
Personal information completed on this form is collected for operational and organizational purposes and is held in strict confidence. This information will be used to determine compatibility of needs and interests of the prospective volunteer and the needs and interests of the hospital and to generate aggregated statistical data. Brant Community Healthcare System volunteer phone numbers and e-mail addresses may be given to BCHS staff or other BCHS volunteers to be used specifically to contact volunteers for Volunteer Association business/shifts.