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Onslow. Memorial Hospital

PFAC – Application

To apply to become a member of the PFAC, please complete the application below. To learn more about the purpose and mission of the PFAC, as well as what is typically expected of council members, click here.

*Date:
*Name:
*Address:
*City/State/ZIP:
*Email Adress:
*Cell Phone:
*How did you hear about the council?
*Describe why you would like to be a member of the Patient & Family Advisory Council?
*Describe your experience(s), positive or negative, as a patient and/or family member at Onslow Memorial Hospital.
*What does “good customer service” mean to you and your family when you use the hospital?
*What are some of the specific things that health care professionals do to help you and your family?
*Share some examples of organizations or committees you have served and your hobbies and interests.
*Please provide the contact information for two references. One reference should be from someone affiliated with Onslow Memorial Hospital and the other reference should be from a community organization. For each, please include a name, along with a phone number and/or email address.
*Required

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