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Patient Engaged Research Center (PERC) Patient Advisor Application

Ways to participate in our program:

Health System Advisor: Serve on Patient/Family Advisor Council or healthcare committee focused on designing or improving a new or current program, service, policy, or process
Research Advisor: Serve as member of funded research projects giving patient/caregiver input on study design, outcome measurement selection, data collection, etc.
Focus Group Advisor: Participate in focus groups and provide feedback on own personal healthcare experiences (one-time).
E-Advisor: Share feedback by participating in online surveys.

*Asterisk indicates required field.

First Name Last Name Email Phone Number Alternate Phone Number Address City State ZIP Code How did you hear about this opportunity? If other, please specify Are you a current Henry Ford Health System patient? If yes, from what location(s) do you receive services?

Skills and Interests

Please describe your professional background or special training, interests, hobbies or experiences you feel are relevant to being a Patient/Family Advisor Please indicate the ways in which you would like to participate in our program (for full explanations, see the top of this page): Health System Advisor Research Advisor Focus Group Advisor E-Advisor I do not know yet I need more information Are you a current Henry Ford Health System employee? Yes No

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Patient Engaged Research Center (PERC) Patient Advisor Application

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