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Patient Advisor Application

Patient Advisor Application

 

 

Patient Advisor Application

Or

Please list two (2) non-family references we may contact:

Reference #1

Reference #2

Conditions of Application

  • I give Chatham-Kent Health Alliance and the Family Experience Council (or designate) permission to discuss my application and the above references provided.
  • I understand the role of the Patient Advisor and can commit time to involvement in Council activities.
  • I understand that my application does not guarantee me a position as a Patient Advisor.
  • I understand that I can withdraw my application at any time.
  • I understand that if selected to become a Patient Advisor, I will be required to complete the orientation process including, but not limited to, providing a Police Clearance, undergoing a Health Review and attending an orientation session.

If under 18 years of age, we require parental/ guardian consent for application. 

I understand that my child named in this application wishes to be considered for volunteer work and I hereby give my permission for them to serve in that capacity, if accepted by the Chatham-Kent Health Alliance. I understand that they will be provided with orientation and training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the requirement of heir position, including regular attendance and adherence to Alliance polices and procedures. I understand they will not receive monetary compensation for their services contributed.

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Chatham Campus

Chatham Site

80 Grand Avenue West
P.O. Box 2030
Chatham, ON N7M 5L9

Sydenham Campus

Wallaceburg Site

325 Margaret Ave
Wallaceburg, ON N8A 2A7

1.519.352.6400