E-Advisor Sign Up

Welcome to the Boston Children's E-Advisors sign-up page! Thank you for your interest in the program and for taking the time to create an E-Advisor profile. Answering the questions below will help us better tailor requests around your specific experiences. The information collected will be kept confidential and used only for improvement work. Once you submit your completed sign up form, you will receive a follow up email (typically within one week) to confirm your membership as a Boston Children’s E-Advisor. This email will also provide you with some guidelines for the program including how you can expect to be contacted for feedback and insights. If you have any questions or concerns, please reach out to the Family Partnerships team at FamilyPartnerships@childrens.harvard.edu.

I am a Boston Children's:*

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I am a Boston Children's:*

First Name*

Last Name*

Preferred email address to receive e-advisory communications:*

City/Town that you live in*

State that you live in*

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

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

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

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What is your race? Mark all that apply:*

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Please share with us any races that best describe you.

What is your age?*

Please note: E-Advisors must be 16 years or older

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What is your gender?*

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What is your gender?*

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

Check all that apply.

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

Check all that apply.

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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?*

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Is there any other information you would like to provide?

In my role as a Boston Children's E-Advisor, I understand that I must maintain confidentiality of the information shared with me, as well as any other data I may come in contact with. I also understand that information shared will often be a draft version and not yet finished. I will not forward or share information I have access to as an E-Advisor unless I am specifically asked to do so.*

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