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Patient and Family Advisory Council Membership Application

Thank you for your interest in the Patient and Family Advisory Council. Membership requires your successful completion of the registration process with Tampa General Hospital, including but not limited to: a criminal background check, a formal interview process, a mandatory orientation, and - if applicable - a health screening, which may include TB testing. All your information will be treated as confidential.

  • * denotes mandatory fields
Preferred Phone Number *(Required)
Preferred Time of Contact *(Required)
Have you EVER been convicted of a crime, plead guilty, nolo contender (no contest) or had adjudication withheld? *(Required)

A criminal conviction will be considered only as it applies to the volunteer position for which you are applying. The seriousness, nature of the offense, time lapsed, and rehabilitation will be taken into account.

Please indicate your willingness to share your contact information with other members *(Required)

Do you have experience with public speaking? *(Required)
Are you comfortable speaking in a group setting? *(Required)

Sharing stories about your experiences – positive and negative – is an important way to gather insights about each other and better understand how the patient and family experience can be improved. Please share a story here about a healthcare experience that impacted you in some way. (1000 word limit)

Examples might include someone’s experience with childbirth, being admitted through the emergency room unaccompanied by a family member, or the hospitalization or death of a loved one. It could be about a physician’s lacking bedside manner, or when a nurse went above and beyond.

What is the easiest way for you to participate in meetings? *(Required)
Acknowledgement *(Required)

TGH Adult Patient and Family Advisory Council (PFAC) is committed to accessibility, diversity, inclusion and meeting the needs of all of our applicants and members, including those with disabilities. If you have found that our website or application process is not providing that level of commitment to you or if you are experiencing any difficulties with the PFAC website or application, please report them to Kristen Woodruff, Patient Advisory Coordinator at kwoodruff@tgh.org.