Patient and Family Advisory Council Application

Thank you for taking the time to complete this application for The Bellevue Hospital’s Patient and Family Advisory Council (PFAC).

The PFAC will be comprised of current and former patients, family members and clinical staff of The Bellevue Hospital. The council will meet to work together to make enhancements in patient safety, quality and experience.

The goals of the council are:
• Provide insight to hospital leaders and staff about patient and family healthcare needs
• Work with staff to improve patient and family services
• Improve patient safety, quality and experience
• Serve as a patient family advisor working with us in the planning of patient care areas and
patient programs

The benefits of joining the PFAC include:
• Being part of a team
• Making a difference in the lives of our patients, family and staff
• Meeting new people who have had similar experiences as yours

The Patient and Family Advisory Council will meet routinely at The Bellevue Hospital.


I certify the statements made in this application are true and I understand the misrepresentation and/or withholding of information may result in the rejection of this application or my discharge if discovered after volunteer service begins. Current PFAC members will interview and choose volunteers they feel are best suited based on group consensus. I am authorizing the PFAC members, by signing this, to discuss my participation in the program with my clinical care staff. My signature indicates approval for The Bellevue Hospital to check references.

Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, gender, gender identity or military status.