Updated on: Jun 27, 2024Please fill out the form below if becoming a PFA interests you!First NameLast NameAddressCityPostal / Zip CodePhoneEmailHow would you like to be followed up with?PhoneEmailI am aPatientFamily Member or CaregiverAre you currently coming to the cancer center for treatment or appointments?YesNoIf No, are you a former cancer patient or caregiver of a cancer patient, when as your last treatment or visit to a cancer centre?<1 year1-3 years3-5 years>5 yearsAs a PFA, I would be interested to (check all that apply):Share my story (personal cancer care experiences)Participate in discussion or focus groupsReview or help create educational or information materials and website resourcesWork on short term projectsWork on ongoing projects/committeesServe on the Patient and Family Advisory Council (monthly meetings with PFAs)Review patient and family experience surveysGuide strategy and policy development and implementation (standards for care, experience and long term goals)Advise on the outpatient and/or inpatient cancer experience (e.g. services and types of programs for care)Advise on the how different areas look and feel, how patients move around the cancer centre and hospitalImprove how patient’s care is transferred between different settings (e.g. family doctor and cancer care)Participate in interviews for staffParticipate in engagement opportunities hospital wide and beyondProvide guidance around communication with patient, family members/caregiversAdvise on how technology could be used to improve care and patient experiencePlease share any other interests you haveWhy are you interested in participating as an advisor?Have you previously served at another organization as an advisor, committee member or volunteer? If yes, please tell us about your experienceHow did you hear about becoming a PFA?Poster/brochure in the cancer centreStaff memberA current PFAGrand River Hospital websiteFamily, friend, caregiverOtherI understand that:this application and/or being interviewed does not guarantee a position as a PFA.prior to beginning as an advisor, I would need to participate in PFA orientation.I will need to sign a Confidentiality Agreement and Conflict of Interest disclosure.I understand that I can withdraw my application at any timeSubmit
