Improve

Join our Patient & Family Advisory Program

Thank you for choosing UCLA Health for your healthcare!

We would like to invite you to join the UCLA Health Patient & Family Advisory Program - a community of UCLA Health patients and families who are directly involved in evaluating and improving the UCLA patient and family experience. Patients and families are at the heart of everything we do. We are very interested in your participation and hope you will join us.

Patient Advisor Preferred Qualities:

  • Share their personal experience as patient or family member
  • Are motivated by helping us improve our services
  • See beyond personal experiences to the “bigger picture”
  • Are comfortable with expressing opinions in a group
  • Ability to listen to differing points of view
  • Ability to interact well with people of different backgrounds

How You Can Help

Please tell us a little bit about yourself by completing the questionnaire below.  If you are selected to move forward with the process, you will be invited to participate in discussions, in-person events, and other surveys on various topics related to improving the UCLA Health patient and family experience.

Once again, thank you for your interest in the UCLA Health Patient & Family Advisory Program!

The UCLA Health Patient Experience Team

 

Name (First Last) (required)

Address (Street, City, State, Zip)

Phone (required)

Email (required)

Best Way to Contact You

When is the best time for you to participate?

You are a...

Have you or your family member been seen at UCLA Health in the past year? (required)

If a family member, you are the patient's...

Which department(s) provided care for you or your family member? Please check all that apply.

Where have you or your family member received care? Please check all that apply.

If you were referred to be a patient advisor, please let us know who referred you.

Please tell us why you would like to be a patient advisor (250 characters max).

Please check which activity or activities would interest you.

Date of Birth (MM-DD-YYYY)

Occupation

What areas are you especially interested in? Please check all that apply.