Patient & Family Advisory Council (PFAC) Application Form

*First Name *Last Name Email *Phone *I have been a University Health patient

Yes No *I am a family member of a University Health patient

Yes No *I am available to meet 10 times a year

Yes No *Which PFAC would you be interested in participating on? *In a few sentences, please explain why you would like to be a member of the University Health PFAC Loading Form This form failed to execute the request. Please refresh the page and try again.