Patient and Family Advisory Council (PFAC)

We want to hear from you! Variety Care is assembling a team of patients and employees to take surveys and review Variety Care policies and procedures to ensure we're doing our best to serve the community.

Eligibility Requirements:

  • Must be an established patient at Variety Care
  • Must be at least 18 years old

Interested in joining? Fill out the application below:

Patient and Family Advisory Council Application

All information provided in this application is voluntary and will be treated as confidential. Thank you.

Have you received care at Variety Care in the last 18 months?
If not, has a family member received care at Variety Care in the last 18 months?
Will you be able to attend monthly PFAC meetings for at least two years?
Do you have any potential conflicts of interest to report?
Have you ever been put on an exclusion list for any Federal or State programs?
Do you feel like you could share your opinion and work with different people toward a common goal?
Are you willing to learn about privacy laws?
Please list your availability:
Which day(s) of the week are you available for a meeting? Check all that apply:
On Mondays, what is your availability?
On Tuesdays, what is your availability?
On Wednesdays, what is your availability?
On Thursdays, what is your availability?
On Fridays, what is your availability?
On Saturdays, what is your availability?
On Sundays, what is your availability?

Notice

The PFAC Steering Committee will review applications and choose volunteers to interview via Zoom, Microsoft TEAMS or another available remote meeting platform. If you are selected for an interview, the meeting will be recorded so all steering committee members can review the candidates to select final PFAC members. By submitting this application, you acknowledge and agree to have your interview recorded.

 

Permissions

Please answer the following statements. Your answer will not affect your eligibility to become a member.

If I am selected as a PFAC member, I give Variety Care permission to share my name, community, organization, and photo on their website.
If I am selected as a PFAC member, I give Variety Care permission to tag me in social media and website content about activities related to the council.

Electronic Signature

By submitting this electronic application, I agree that I have verified my selections about the use of my name, photo and social media information for use by Variety Care.