Patient and Family Advisory Council

Apply for Patient and Family Advisory Council (PFAC)

• PFAC

• Patient Information

  Name *

  Address *

  Primary Phone *

  Secondary Phone

  Email Address *

  Gender *

  Male Female

  Age Range

  18 - 25

  26 - 41

  42 - 57

  58 and above

  Language Spoken

  English Arabic French Spanish Other

  Relationship

  Patient

  Parent

  Spouse

  Sibling

  Other

  I/my family member was treated in...

  Educational Level

  High School

  Bachelors

  Doctorate (PhD)

  Associate

  Masters

  Other

  Have you ever volunteered at Danat before? (If yes, years(s) and area(s):)

  Have you or a loved one received care at Healthplus? Please check all that apply

  Outpatient

  Inpatient

  Other programs, services

  Which facility did you or a loved one receive your care at? Please check all that apply

  HealthPlus Diabetes & Endocrinology Center

  HeathPlus Family Clinic - Al Bandar

  HeathPlus Family Clinic - Al Forsan

  HeathPlus Family Clinic - Saadiyat Island

  HealthPlus Fertility Center - Abu Dhabi

  Have you ever volunteered at Healthplus before? (If yes, years(s) and area(s)

  Yes

  No

  Volunteer Year and Area

  Tell us about how you can help the Patient and Family Advisory Council (PFAC)

  Why would you like to be a member of the PFAC?

  If you have served on other advisory councils and boards, or as a volunteer with other groups, please briefly describe that experience?

  The key attributes of a good PFAC member include being a good listener, having excellent communication skills, respecting the opinion of others, working collaboratively, and maintaining confidentiality. Do you believe you have these attributes and why?

  What special interests, experiences or talents would you offer the PFAC?

  The PFAC generally has 4 core meetings every year. Ad hoc meetings may be scheduled as operational needs demand. Do you prefer to attend the core meetings

  In person

  Online

  Choose a time slot that would suit you best so you can attend the core and ad hoc meetings

  Daytime 7 AM – 5 PM

  Evening 5 PM – 8 PM

  Saturday or Sunday

  Tell us about your or your family’s experience at Healthpoint. What would you improve about this experience? What impressed you about it?

  What would be the top 3 areas you can share insight on to improve the experience og AH residents and their families?

  PFAC members frequently communicate through email and using Word/Excel/ PowerPoint. Are you able to use email and receive documents in these formats?

  Yes

  No