Family Advisory Council Interest Survey

Thank you for your interest in learning more about the Boston Children’s Hospital Family Advisory Council! Insights from our patient and family community help us to improve aspects of the care we provide to our patients and their families. Please note that applicants must have a child who has received care at Boston Children’s within the past 12-months. Please visit our website to learn about other opportunities that may be of interest to you and/or your child: https://www.childrenshospital.org/patient-resources/lend-your-voice If you have any questions or concerns, please reach out to the Family Partnerships team at FamilyPartnerships@childrens.harvard.edu.

I am the parent/caregiver of a patient who has received care at Boston Children’s in the past 12 months.*

Select

First Name*

Last Name*

Preferred email address:*

City/Town that you live in*

State that you live in*

Select

What country do you live in?

What is the primary (main) language spoken in your home?*

Select

If you answered “Other,” what is the primary language spoken in your home?

Are you of Hispanic, Latino, or Spanish origin?*

Select

What is your race? Mark all that apply:*

Select

Please share with us any races that best describe you.

What is your age?*

Select

What is your gender?*

Select

If you answered “Other,” what is your gender?

Where have you/your child received care from Boston Children's? (at any time)*

Check all that apply.

Select

Please check the specialty area(s) at Boston Children's where you/your child has received care (at any time).*

Check all that apply.

Select

What other areas have you/your child received care in at Boston Children's?

Within the past 12 months, how many times have you/your child received care at Boston Children's?*

Select

Please tell us a little bit about why you are interested in joining the Family Advisory Council.*

Is there any other information you would like to provide?

Send me a copy of my responses

Privacy Notice|Report Abuse