Patient & Family Advisory Council

The Conway Regional Patient and Family Advisory Council (PFAC) is dedicated to assuring the delivery of the highest standards of comprehensive and compassionate health care fostering partnerships among patients, families, and health care providers. We act as an advisory resource to leadership and staff of Conway Regional Health System. We are a group of local community members who have received care at Conway Regional or who have had family members that have received care. We volunteer our time to promote collaboration between the community and the health system to improve patient care and outcomes.

In our efforts to improve patient and family health care, we request your feedback/suggestions. Please submit your feedback and suggestions to [email protected]

Interested in Serving on PFAC?

If you are interested in serving on the Patient and Family Advisory council, please complete this short questionnaire to help us understand how your background and experiences might fit with the council. A hospital representative may call you to discuss your interest. If you have any questions about joining the council, please email [email protected]

Time Commitment: attend at least 8 out of 12 meetings per year for a term of two years. Meetings will be no longer than two hours. We do not expect you to have experience working in health care; we are interested in your experiences as a consumer of health care services.

First Name*

Middle Initial

Last Name*

Street Address*

City*

State*

Zip*

Phone Number*

Email*

Have you or any of your family members been hospitalized at Conway Regional Medical Center?*

Relation to Patient*

If yes, date of first admission:

Date of last admission:

Which patient care units have served you or your family?

Have you or any of your family members used outpatient services at Conway Regional Medical Center?*

Which services or clinics were used and when?

Why would you like to be on the Patient & Family Advisory Council?*

What areas of concern do you have that you would like to see the Patient & Family Advisory Council address?*

We believe the Patient & Family Advisory Council should reflect the diversity of families who are consumers of hospital services. In light of this, please share anything about yourself that you think would add to the diversity of our council.*

What special interests or experiences would you like to offer to the council?*

Best time to receive calls:*

Daytime
Evening
Weekends

Best time for meetings:*

Daytime
Evening
Weekends

Age range:*

20-30
31-40
41-50
51-60
71-70
70+

Primary language spoken:*

Other language(s) you speak:

Would transportation or childcare be an issue?*

If yes, please explain:

Would you be able to make a commitment of 2 years?*

If no, for how long would you be able to make a commitment?

Electronic Signature*

Date*

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