Community Engagement Advisory Network (CEAN) Patient & Public Involvement in Healthcare
Application Form

Please fill out the form below if you are interested in joining CEAN.


Address
Please tell us which of the following describe you? (Please check all that apply)
Why are you interested in patient/public involvement with healthcare services?
Please tell us about your connections to (and/or work with) community groups and networks (e.g. faith groups; online networks; neighbourhood, student or professional associations, etc.)
What do you hope to gain from your experience with CEAN?
How did you hear about CEAN?
I am interested in the following areas of healthcare
I would like to be involved in the following way(s): (Please tick all options that interest you)
I would be interested in acting as an advisor on the content and user-friendliness of patient information materials
I would be interested in joining a patient reference group or advisory committee
I would reply to questionnaires or surveys that were sent to me about health services
What time would you normally be available for these activities? (Please check all that apply)
We are fostering the growth of a diverse network of advisors. Please tell us a little more about yourself: 
Age Range:
Gender:
Ethnicity:
Thank you. Click 'finish' below to submit your application. A staff member of our department will get in touch with your within the next week or so. If you don't hear from someone, or if you have any questions or would like to speak to someone in person, please e-mail ce@vch.ca or call 604-714-3779.