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Thank you for your interest in the Patient Family Advisory Committee. Membership on the Committee requires successful completion of the registration process, including: formal interviews as well as a mandatory volunteer orientation.  All of your information will be treated as confidential.  Membership on this Committee requires attendance at monthly Committee meetings and possible participation on other committees of your choice.

* Indicates required information
First Name * 
Last Name * 
Email Address * 
Home Phone * 
Work Phone 
Street Address 1 * 
Street Address 2 
City * 
State * 
Zip * 
Please indicate which service you or your family members have used at Edward * 







If Other, please specify:

If a family member received services, what is your relationship to the patient? 
If the patient is a pediatric patient, is the applicant the legal guardian? 
Why would you like to become a member of the Committee? * 
Please describe your encounter with Edward Health Services or Edward Medical Group * 
What part of your life or work history could possibly benefit the Committee? * 
Have you been convicted of a felony or misdemeanor? * 
I certify that I have read the Conditions of Volunteer Services available at www.edward.org/PFAC 

If you are applying as a family member and the patient is not a minor, please include the patient's name. 
   



 

(630) 527-3000

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Edward Hospital & Health Services
801 S. Washington, Naperville, IL 60540 • (630) 527-3000

Naperville • Plainfield • Bolingbrook • Oswego • Woodridge
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