Get Patient Partner Application Form

Completing the Patient Partner Application Form online is an important step towards engaging with your healthcare community. This guide provides clear instructions to help you successfully fill out each section of the form with confidence.

Follow the steps to effectively complete the application form.

1. Click ‘Get Form’ button to obtain the Patient Partner Application Form and open it in your browser.
2. Begin by filling in your name, which includes both your first and last name, in the designated fields. Ensure the spelling is accurate to avoid any confusion.
3. Next, enter your home address along with your city, province, home number, postal code, and cell number. This information is essential for contact purposes.
4. Provide your email address and select your preferred method of contact by checking one of the options: home phone, cell phone, or email.
5. In the section designed to gather more information about you, check the boxes that apply in relation to your experiences as either a patient at STEGH or a family caregiver. You may also indicate your willingness to share your experiences and ability to work with others.
6. Indicate when your care experience at STEGH took place by checking all relevant years. This helps the organization understand your timeline in relation to their services.
7. List the languages you speak in the provided field to help the team understand your communication capabilities.
8. Identify which hospital program you received care from or for which program you served as a caregiver. Provide the names of the relevant units or programs.
9. Respond to the questions concerning any current or past affiliations you may have had with STEGH by checking the appropriate boxes.
10. Indicate how much time you can commit as a Patient Partner by selecting one of the options regarding monthly hours.
11. Answer the question about your availability to serve for at least one year and attend a minimum of five meetings by selecting either yes or no.
12. Express your interests in helping as a Patient Partner by checking any of the provided options that resonate with you.
13. Provide your personal insight about your motivation for becoming a Patient Partner and any information that could contribute to the diversity of the group.
14. Finally, ensure you have two references complete the Patient Partner Reference Check and prepare to return your completed application form to the designated contact via email or postal service.
15. Once you have finished filling out the form, you can save your changes, download a copy, print it, or share it as necessary.

Complete your Patient Partner Application Form online today to play an active role in improving healthcare experiences.