Patient Advisors Network Membership Request

Please tell us a bit about yourself, your healthcare interests, and your experience of being an advisor in healthcare. 

Once we receive the form, we will be in contact with membership details.

Regards, the PAN team

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Province/Territory:*
Country:*
Have you ever worked in healthcare or are you currently employed in healthcare?:*
Current status:*


Do you have experience as...

(Check all that apply.)

I am a:*
I have experience taking care of the following people with health issues.

Areas of Experience and Interest

ACUTE CARE
PRIMARY CARE
COMMUNITY CARE
LONG TERM CARE
MENTAL HEALTH CARE
REHABILITATION FACILITY
FOR THE HEALTH SYSTEM On an advisory group or council for
RESEARCH (NOT as subjects of research but as partners)
EDUCATION
SECTOR INTERESTS My sector interests are in:
HEALTHCARE INTERESTS My healthcare interests are:
PARTNERING ISSUES I am interested in the following partnering issues:

Thank you for sharing your experience and interests. You will hear from us soon.

Regards,  The PAN Team

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